Depression in Children and Adolescents
This slim and timely volume underscores the call by responsible leaders in the field for increased rigorous research on depression in children and adolescents, its early recognition, interventions, and particularly the effectiveness of psychopharmacological agents. In also advocating such efforts, the authors and editors have anticipated the recent outcry in the press and by government leaders against what is inaccurately characterized as irresponsible use of untested medicines in little children.
Although the chapters are uneven in clarity and rigor, all are interesting, reflect considerable experience, and provide useful reading for those professionally concerned with affective disorders in the school-age population. The book is a compact overview of the field, mostly up to date, usefully summarizing areas in which useful information exists as well as areas in which research is needed.
All of the contributors are British or Canadian. The bibliographies are quite useful, but there are some surprising omissions of significant United States investigators such as Cynthia Pfeffer and Joe Biederman. In some respects the viewpoint from outside the United States offers an advantage to U.S. readers by highlighting similarities that transcend cultural differences as well as by providing different perspectives, notably those of Dr. Finn Cosgrove on psychopharmacology of depression in children.
In his chapter, Cosgrove advises against use of tricyclic antidepressants for children because of "their potentially lethal side-effect profile," the risk of fatal arrhythmia. This caution is extreme in contrast to prevailing practice here, where, with the exception of desipramine, which is avoided, tricyclic antidepressants are widely prescribed for children and regarded as often effective. Although electrocardiogram screening is advisable, the risk is deemed minimal.
Cosgrove's recommendation of using the stimulants (methylphenidate, dextroamphetamine, and pemoline) for depression in children also differs from prevailing practice in the U.S. He does not cite any literature demonstrating the antidepressant effectiveness of stimulants in children (and I am unaware of any). His stressing the need for careful double-blind studies of medications in depression cannot be faulted.
Dr. Julian Brockless focuses on the persistent vagueness in the demarcation between normality and pathology in depression, quoting Storr: "Depression is not an illness, but a psychobiological reaction which can be provoked in anyone. It is much more easily provoked in some people than in others." He also schematically summarizes different meanings given to the concept of depression by different authors and their overlapping diagnostic criteria.
The chapter by Dr. Mary Evans and Ann Murphy on cognitive-behavioral treatment provides a good review of the literature and summarizes encouraging evidence of success by this approach. They include illuminating accounts of their experiences with a cognitive-behavioral group for latency children.
The perspectives in most chapters and the inclusion of pediatric, family practice, educational, and social work perspectives reflect the editors' laudable promotion of closer collaboration between all societal and professional areas concerned with children, adolescents, and their families in addressing the serious problem of the depressive disorders in childhood. The challenges and needs of the field are well summarized in the final chapter by Dr. Philip Barker.
Dr. Gair is professor of psychiatry and chairman of the department of child psychiatry and child development at Boston University School of Medicine.
