BMJ  2005;330:418-419 (19 February), doi:10.1136/bmj.330.7488.418-c

Letter

Rethinking childhood depression

Summary of responses

Timimi argues that unhappiness among children seems to be rising, but labelling it as depression and prescribing antidepressants is ineffective and possibly harmful: it is time to focus on the underlying reasons. Many respondents agree, but whether the term depression is apt, whether what is under discussion is a disease or a normal reaction to life's events, and whether the normal range of human emotion is being made into a disease are debated.¹ The role of the family and what family life teaches children, the impact of the mass media and consumerism, the importance of nutrition, the diversion of resources in a cash strapped health service, politics, and toxic environments are some of the factors singled out as influencing children's health and wellbeing.

Several respondents explicitly reject drugs as a treatment modality—something which is taken up in the responses to the commentary by Wilkinson²—citing a press release from the European Medicines Agency that declares fluoxetine unsuitable for children.

Although there is no real dispute about whether childhood depression exists, what-ever name you choose to give it, the condition might not be taken seriously if it is not given a serious enough label. Most respondents seem to see the causes for unhappiness in children in the way society operates, in traditional family structures falling apart, in the environment being hostile at many levels, and possibly in the intertwined interests of political rulers and the pharmaceutical industry.

All but one respondent agree that childhood depression is a discrete disease entity, different from adult depression, requiring its own treatment modalities. As Christine Singh, women's health fellow in Canada, puts it: improving the social determinants of health might be the only hope of "curing" illness such as depression, and money should be shifted towards humanity.

BMJ

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Competing interests: None declared.

References

1. Electronic responses. Rethinking childhood depression. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7479/1394 (accessed 31 January).
2. Electronic responses. A controversy too far? http://bmj.bmjjournals.com/cgi/eletters/329/7479/1397 (accessed 31 January).

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