Interesting NYT article on childhood depression

I read with great interest this article in the New York Times by Pamela Paul on childhood depression.

According to the article, researchers now believe that depression can be diagnosed in children as young as 2 or 3 years old, and the idea is apparently gaining wide acceptance in the medical community.  The article quotes researchers who insist that only “hard-core scientists” and “laypeople” remain skeptical.

To me, the fact that “hard-core scientists” have reservations about this theory is a red flag and a cause for serious concern and not a sign that the ideas behind it are ready for wide application.  What is reported in the following excerpt also concerns me:

Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.

Perhaps I am interpreting this quote the wrong way, but can anyone blame me for feeling that the drug companies are drooling over the prospect of expanding the market for their anti-depressant drugs to include pre-schoolers and other children?

Let me repeat that last part again:

They want to give these kids medicines, but we can’t figure out the diagnoses.

Does that not sound like a solution looking for a problem?

I must admit that I am not completely surprised by this new direction. I have read a number of times recently that it is becoming increasingly common for autism in children to be diagnosed in combination with other disorders, particularly bipolar disorder, with some children being prescribed anti-psychotic medication. While I understand that the use of anti-psychotic medication is controversial in the treatment of autism and is certainly not the norm- yet – it is a disturbing trend, nonetheless. I’m afraid that I just do not understand how bipolar disorder, which often involves psychotic episodes, characterized by delusions and hallucinations, could be definitively diagnosed in a child who most likely lacks the means of describing the symptoms. I mean, how would a doctor determine that a 3 year old autistic child has false beliefs?

I understand that I’m very likely exaggerating the bipolar/autism issue, and I suspect that in general it is not really the psychotic aspect of bipolar disorder that is considered relevant to autistic children but rather the other symptoms (e.g., difficulty shifting focus, manic enthusiasm for a single topic, periodic depresseive episodes, etc.). Certainly more investigation of this particular issue by me would be helpful (I will put it on my future blog posts list).

In the meantime, I will let people read the article and draw their own conclusions about the appropriateness of diagnosing children with depression. However, I will say that, while it is clear that I am one of those aforementioned “laypeople” who feel that, without more evidence, there is likely more harm in the diagnosis than benefit (particularly if it’s accompanied with a prescription for a drug that is not even particularly effective in relieving the symptoms of depression in adults), as in all things, I will continue to follow the issue and keep an open mind. If the treatment is limited to non-pharmaceutical therapies that can be scientifically demonstrated to result in an improved quality of life in the long run for children who qualify for this label, then I am not against it. Why would I be?

I should also say that I do believe, as is noted in the article, that it is important to exploit the high-plasticity of children’s brains by giving them therapy at a time when it is most effective. Children with autism who receive intensive behavioural therapy (IBI) have been benefiting from this  for some time now. However, this is a double-edged sword, as giving the wrong therapy to children, particularly inappropriate drug therapies, is likely to have the potential for a greater damage than it would for adults.

– Dave


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