BMJ  2004;329:1397 (11 December), doi:10.1136/bmj.329.7479.1397

Commentary

a controversy too far?

¹ Section of Developmental Psychiatry, University of Cambridge, Cambridge CB2 2AH pow@fsmail.net

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

The use of antidepressants in depressed children (here referring to both children and adolescents) is controversial. Timimi takes this issue further by questioning the validity of the diagnosis of depression in childhood.¹ Here the author is out of step with what is known.

Epidemiological studies using reliable psychiatric methods have established beyond doubt that the full range of depressive symptoms are present in representative samples of children. It is true that there is a spectrum of depressive disorders, with an arbitrary cut-off point of five symptoms for the diagnosis of unipolar major depression in DSM-IV and ICD-10. However, children with this major depression (diagnosed by standardised psychiatric interviews) do have specifically increased risk of adulthood depression compared with children with non-affective psychiatric disorders and well controls.² Furthermore, children with clinical depression are more impaired than unhappy children with fewer symptoms.³ From the physiological perspective, raised concentrations of the steroid hormones . . . [Full text of this article]

Future diagnosis

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