The Depressions in Childhood and Adolescence

When One, examines most textbooks on child psychiatry, he finds little or no mention of depressions in childhood. As an example, in the third edition of Child Psychiatry by Leo Kanner, the word “depression” is neither listed in the table of contents nor in the index of this otherwise excellent text. This is surprising since all psychiatrists have seen depressed children. As a matter of fact, with growing experience and awareness of this condition, such a diagnosis is being made more often. In this paper, I will explore the concepts of depression in childhood and adolescence and, through the use of clinical examples, develop means for a more effective diagnosis of this condition with the hope that early identification can lead to the prevention of some of the disabling depressions of adults.

Let us first recall what the classical clinical picture of depression in adults is. Dr. Hans Lehmann¹ describes it very well: “Fortunately there has always been agreement about the phenomena that characterize the psychiatric condition which we call depression or melancholia. The characteristic symptoms are a sad or despairing mood, decrease of mental productivity and a reduction of drive, retardation or agitation in the field of expressive motor responses. These might be called the primary symptoms of depression. The group of secondary symptoms comprises feelings of hopelessness, hypochondriacal preoccupation, feelings of depersonalization, obsessive and compulsive behavior, ideas of self-accusation, nihilistic delusions, paranoid delusions, hallucinations, suicidal rumination and tendencies. Insomnia, anorexia and weight loss are usually associated with depressive states… The sad, despairing emotional state and depressive mood seem to constitute the real core of all depressions …”

The foregoing excellent clinical description of depression is rarely seen in childhood; if we were to diagnose depressive illness in children using Dr. Lehmann's definition, we would be talking about ve