Intended for healthcare professionals


Depression in children

BMJ 2002; 325 doi: (Published 03 August 2002) Cite this as: BMJ 2002;325:229

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.

Competing interests: No competing interests

07 August 2002
Joel Kanter
Silver Spring, Maryland 20910