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EDITORIALS: Philip Hazell Depression in children BMJ 2002; 325: 229-230 [Full text]

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Children and depression

Joel Kanter   (7 August 2002)

Children and depression 7 August 2002
Joel Kanter Silver Spring, Maryland 20910 Send response to journal: Re: Children and depression	Unfortunately, Hazell's editorial on treating depression and children makes little attempt to understand childhood unhappiness apart from the "illness" of depression. Many, and perhaps most, depressed children have good reasons to be depressed: parental loss, separation, divorce, abuse, neglect, poverty, poor schools, ostracism from peers, etc. With family support in decline in many communities, these difficulties have become increasingly pronounced. It is particularly sad when mental health professionals either focus solely on symptom control (i.e. medications) or on cognitive-behavioral approaches which suggest the child's thinking is awry. Interpersonal psychotherapy (IPT) a la Klerman and Weissman has shown excellent outcomes with depressed adults; in this approach, actual losses and injuries are explored and validated. Such a perspective is critical with children growing up without the familial support and continuity we often take for granted. Unfortunately, because children often express their suffering in an indirect manner, it is difficult to manualize psychotherapy techniques for empirical study. Communicating with children without creativity and humor is likely to lead to treatment failure--regardless of the intervention used.