Education And Debate

Rethinking childhood depression

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7479.1394 (Published 09 December 2004) Cite this as: BMJ 2004;329:1394
  1. Sami Timimi (stimimi@talk21.com), consultant child and adolescent psychiatrist1
  1. 1 Lincolnshire Partnership NHS Trust, South Rauceby, Sleaford, Lincolnshire NG34 8QA
  • Accepted 7 October 2004

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

Introduction

Increasing numbers of children are being treated for depression. At the end of 2003, over 50 000 children were prescribed antidepressants, and over 170 000 prescriptions a year for antidepressants were issued to people under 18 years old in the United Kingdom.1 Recent evidence has suggested that selective serotonin reuptake inhibitors are largely ineffective and may be dangerous in this age group.2 3 Older antidepressants have already been shown to have no beneficial effect in people under 18.4 So how did we get into this mess? Undoubtedly part of the problem is with pharmaceutical industry tactics, designed to enable greater consumption of their products.3 However, the gateway diagnosis to prescribing antidepressants to under 18s is that of childhood depression. In this article I discuss the notion of childhood depression and suggest that the medicalisation of children's unhappiness is hindering our ability to respond effectively to this problem.

Meaning of childhood

Western society's ideas about childhood and child rearing have changed radically in the past 60 years. The West's attitude to child rearing changed from viewing relations between adults and children primarily in terms of discipline and authority to a focus on permissiveness and individual rights.5 In addition, whereas the model used before the second world war prepared children for the workplace within a society of scarcity, the post-war model prepared them to become pleasure seeking consumers (along with their parents) within a prosperous new economy.6

Shifting economic structures also led to profound changes in the organisation of family life. Suburbanisation and the economic demands of successful market economies resulted in greater mobility, less time for family life, and …

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