Labelling unhappy children as depressed may be harmful

Unhappiness among children seems to be rising, but labelling it as depression and prescribing antidepressants is ineffective and possibly harmful, warns a child psychiatrist in the BMJ.

Increasing numbers of children are being treated for depression. At the end of 2003, over 50,000 children were prescribed antidepressants, however, the author argues that anti-depressants are ineffective and some may be dangerous in this age group.

So how did we get into this mess, asks the author? Undoubtedly, part of the problem is with pharmaceutical industry tactics, but changes in Western cultural beliefs have also resulted in more childhood behaviours being viewed as a medical problem.

With little clinical evidence to support the idea that childhood depression exists as a distinct clinical category, it is time to focus on the underlying reasons for increasing unhappiness in young people, she says. Childhood depression, as a label, may need to be abandoned and a multiperspective approach adopted to deal with children's unhappiness.

In two accompanying commentaries, experts agree that non-medical therapy is an important component of treatment, but they warn against abandoning the diagnosis of depression in children.

The danger of abandoning the diagnosis is that the evidence base for effective psychological and pharmacological treatments may also be disregarded, writes consultant psychiatrist Quentin Spender.

Research psychiatrist, Paul Wilkinson believes that though it is wrong to neglect psychosocial treatments, it is equally unacceptable to neglect evidence based drug treatments for those who may truly benefit and recover from a mental disorder that carries serious risks for recurrence into adult life.

Contacts:
Paper: Sami Timimi, Consultant Child and Adolescent Psychiatrist, Lincolnshire Partnership NHS Trust, Lincolnshire, UK
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Commentary 1: Quentin Spender, Consultant, Chichester Child and Adolescent Mental Health Services, Chichester, UK
Email: [email protected]

Commentary 2: Paul Wilkinson, Research Psychiatrist, University of Cambridge, UK
Tel: +44 (0)1223 746 001 x 6077
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Click here to view full paper and first commentary
Click here to view second commentary