Rethinking childhood depression
http://www.100md.com
《英国医生杂志》
1 Lincolnshire Partnership NHS Trust, South Rauceby, Sleaford, Lincolnshire NG34 8QA stimimi@talk21.com
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
Just as our concepts of childhood have changed, so have our concepts of childhood problems. It was only in the late 1980s that our understanding of childhood depression began a far reaching transformation. Before this, childhood depression was viewed as very rare, different from adult depression, and not amenable to treatment with antidepressants.11 A shift in theory, and consequently practice, then took place as influential academics claimed that childhood depression was more common than previously thought (8-20% of children and adolescents), resembled adult depression, and was amenable to treatment with antidepressants (often resulting in antidepressants becoming a first line treatment3).4 12
Childhood depression has become a popular notion, reflecting the broader cultural changes that have taken place in our view of childhood and its problems. These days we are as likely to use medicalised terminology to describe children's feelings (such as depressed) as we are less pathological descriptions (such as unhappy).
How good is the scientific evidence?
Boseley S. 50 000 children taking antidepressants. Guardian 2003 Sep 20: 1.
Ramchandani P. Treatment of major depressive disorder in children and adolescents. BMJ 2004;328: 3-4.
Jureidini J, Doecke C, Mansfield PR, Haby M, Menkes DB, Tonkin A. Efficacy and safety of antidepressants for children and adolescents. BMJ 2004;328: 879-83.
Harrington R. Affective disorders. In: Rutter M, Taylor E, Hersov L, eds. Child and adolescent psychiatry, modern approaches. 3rd ed. Oxford: Blackwell Scientific, 1994.
Jenkins H. Childhood innocence and other modern myths. In: Children's culture reader. New York: New York University Press, 1998: 1-37.
Wolfenstein, M. Fun morality: an analysis of recent child-training literature. In: Mead M, Wolfenstein M, eds. Childhood in contemporary cultures. Chicago: University of Chicago Press, 1955: 168-78.
Zuckerman M. Dr Spock: the confidence man. In: Rosenberg C, ed. The family in history. Philadelphia: University of Pennsylvania Press, 1975: 179-207.
Weinman-Lear M. The child worshipers. New York: Pocket, 1963.
Jenhs C. Childhood. London: Routledge, 1996.
Timimi S. Pathological child psychiatry and the medicalization of childhood. London: Brunner-Routledge, 2002.
Gelder M, Gath D, Mayou R. Oxford textbook of psychiatry. 2nd ed. Oxford: Oxford University Press, 1989.
Reynolds WM, Johnston HF. Handbook of depression in children and adolescents. New York: Plenum Press, 1994.
Pickles A, Rowe R, Simonoff E, Foley D, Rutter M, Silberg J. Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance. Br J Psychiatry 2001;179: 230-53.
Wickes-Nelson R, Israel A. Behaviour disorders of childhood. London: Pearson Higher Education, 2002.
Harrington R, Fudge H, Rutter M, Bredenkamp C, Groothues C, Pridham J. Child and adult depression: a test of continuities with data from a family study. Br J Psychiatry 1993;162: 627-33.
Fombonne E, Wostear G, Cooper V, Harrington R, Rutter M. The Maudsley long-term follow-up of child and adolescent depression 1. Psychiatric outcomes in adulthood. Br J Psychiatry 2001;179: 210-7.
Hill P. Child and adolescent psychiatry. In: Murray R, Hill P, McGuffin P, eds. The essentials of postgraduate psychiatry. 3rd ed. Cambridge: Cambridge University Press, 1997: 97-143.
Rutter M, Smith D. Psychosocial disorders in the young: time trends and their causes. Chichester: John Wiley, 1995.
Kincheloe J. The new childhood; Home alone as a way of life. In: Jenkins H, ed. Children's culture reader. New York: New York University Press, 1998: 159-77.
Pampei F, Williamson J. Age patterns of suicide and homicide mortality rates in high-income nations. Social Forces 2001;80: 251-82.(Sami Timimi, consultant c)
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
Just as our concepts of childhood have changed, so have our concepts of childhood problems. It was only in the late 1980s that our understanding of childhood depression began a far reaching transformation. Before this, childhood depression was viewed as very rare, different from adult depression, and not amenable to treatment with antidepressants.11 A shift in theory, and consequently practice, then took place as influential academics claimed that childhood depression was more common than previously thought (8-20% of children and adolescents), resembled adult depression, and was amenable to treatment with antidepressants (often resulting in antidepressants becoming a first line treatment3).4 12
Childhood depression has become a popular notion, reflecting the broader cultural changes that have taken place in our view of childhood and its problems. These days we are as likely to use medicalised terminology to describe children's feelings (such as depressed) as we are less pathological descriptions (such as unhappy).
How good is the scientific evidence?
Boseley S. 50 000 children taking antidepressants. Guardian 2003 Sep 20: 1.
Ramchandani P. Treatment of major depressive disorder in children and adolescents. BMJ 2004;328: 3-4.
Jureidini J, Doecke C, Mansfield PR, Haby M, Menkes DB, Tonkin A. Efficacy and safety of antidepressants for children and adolescents. BMJ 2004;328: 879-83.
Harrington R. Affective disorders. In: Rutter M, Taylor E, Hersov L, eds. Child and adolescent psychiatry, modern approaches. 3rd ed. Oxford: Blackwell Scientific, 1994.
Jenkins H. Childhood innocence and other modern myths. In: Children's culture reader. New York: New York University Press, 1998: 1-37.
Wolfenstein, M. Fun morality: an analysis of recent child-training literature. In: Mead M, Wolfenstein M, eds. Childhood in contemporary cultures. Chicago: University of Chicago Press, 1955: 168-78.
Zuckerman M. Dr Spock: the confidence man. In: Rosenberg C, ed. The family in history. Philadelphia: University of Pennsylvania Press, 1975: 179-207.
Weinman-Lear M. The child worshipers. New York: Pocket, 1963.
Jenhs C. Childhood. London: Routledge, 1996.
Timimi S. Pathological child psychiatry and the medicalization of childhood. London: Brunner-Routledge, 2002.
Gelder M, Gath D, Mayou R. Oxford textbook of psychiatry. 2nd ed. Oxford: Oxford University Press, 1989.
Reynolds WM, Johnston HF. Handbook of depression in children and adolescents. New York: Plenum Press, 1994.
Pickles A, Rowe R, Simonoff E, Foley D, Rutter M, Silberg J. Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance. Br J Psychiatry 2001;179: 230-53.
Wickes-Nelson R, Israel A. Behaviour disorders of childhood. London: Pearson Higher Education, 2002.
Harrington R, Fudge H, Rutter M, Bredenkamp C, Groothues C, Pridham J. Child and adult depression: a test of continuities with data from a family study. Br J Psychiatry 1993;162: 627-33.
Fombonne E, Wostear G, Cooper V, Harrington R, Rutter M. The Maudsley long-term follow-up of child and adolescent depression 1. Psychiatric outcomes in adulthood. Br J Psychiatry 2001;179: 210-7.
Hill P. Child and adolescent psychiatry. In: Murray R, Hill P, McGuffin P, eds. The essentials of postgraduate psychiatry. 3rd ed. Cambridge: Cambridge University Press, 1997: 97-143.
Rutter M, Smith D. Psychosocial disorders in the young: time trends and their causes. Chichester: John Wiley, 1995.
Kincheloe J. The new childhood; Home alone as a way of life. In: Jenkins H, ed. Children's culture reader. New York: New York University Press, 1998: 159-77.
Pampei F, Williamson J. Age patterns of suicide and homicide mortality rates in high-income nations. Social Forces 2001;80: 251-82.(Sami Timimi, consultant c)