BMJ  2004;329:1396 (11 December), doi:10.1136/bmj.329.7479.1396

Commentary

abandoning the diagnosis will endanger severely depressed children

¹ Chichester Child and Adolescent Mental Health Services, Chichester PO19 6PQ spender@sghms.ac.uk

The first 150 words of the full text of this article appear below.

As a family therapist, I applaud Timimi's broadly systemic approach to childhood unhappiness.¹ In my experience, young people aged 14-16 are most likely to present to clinicians with depression, and he is right to emphasise the sociocultural roots of their unhappiness. However, I am concerned at the underemphasis on possible consequences of depression, such as school failure, social withdrawal, antisocial behaviour, substance misuse, family disharmony, and suicide, which are more than just potential comorbidities.

I agree that psychoeducation is an important component of treatment. This includes acknowledging that some life experiences can be more difficult than others, particularly losses; that sleep can be improved by exercise; that mood can be improved by activity scheduling; and that an emphasis on the positive is more likely to help than a focus on the negative. But I cannot see that this is enough; nor do I think that child mental health professionals can . . . [Full text of this article]

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