Source: UPI
Date: 5 May 2006

Ped Med: The young and depressed


SAN FRANCISCO, May 5 (UPI) -- Recent research suggests depression, whose symptoms vary widely across and within the pre-adult age groups, seems to be making its first appearance -- at least on physicians' charts -- much earlier in life than in past decades.

In findings that took aback even those who made them, investigators from the Duke University Medical Center in Durham, N.C., detected signs of depression, anxiety and other mental illnesses in one in 10 of the 307 2-to-5-year-olds they studied -- about on par with older children and not much below the rates reported in adults.

"Thirty years ago, there was a huge debate in the medical psychiatric field whether there was such a thing as childhood or adolescent depression, and no one is arguing that now," said child psychiatrist Dr. Helen Egger, assistant professor of psychiatry at Duke and co-author of the study funded in part by the pharmaceutical giant Pfizer Inc.

"Now, we need to be doing some rethinking again, pushing the question back to even younger than school-age children," she said. "Child psychiatric epidemiology beginning at age 8 or 9 has simply missed the boat."

There are those who think it is such pronouncements that have gone overboard in casting a medical spin over hitherto unremarkable, albeit unpleasant, aspects of growing up.

It is the reclassification of pediatric proclivities -- from skipping school to picking on peers -- as mental maladies that is partly responsible for the startling statistics of childhood psychiatric disorders, they contend.

"The notion of what is psychologically normal and not normal is not a scientific construct but easily influenced by cultural and social forces," maintains clinical child psychologist James Maddux, professor of psychology at George Mason University in Fairfax, Va.

"There's always a suspicion (of) a silent collusion to expand the boundaries of what a mental disorder is because the drug companies can then sell more of their pills and psychiatrists and healthcare professionals can offer quicker fixes with their prescriptions and people can take a quick fix to solve their problems," he said. "The intelligent, informed consumer buys into this, too."

A controversial new book by two Irish psychotherapists goes so far as to define depression as an emotion rather than a disorder, committing what in mainstream medical eyes is scientific heresy.

"The dominant approach in psychiatry, which sees chemical imbalance as the primary cause of depression and medication as its cure, pathologizes sufferers, turning them into damaged goods or victims of flawed chemistry and defective genes," psychiatrist Dr. Michael Corry, co-author of "Depression -- an Emotion Not a Disease" (Mercier Press, 2005), writes on his "Depression Dialogues" Web site.

"Such a view places the problem within the person's brain matter, rather than in their thoughts, feelings and behaviors, and the ways in which they respond to the problems of living," he contends.

"This stringently mechanistic approach marginalizes personal consciousness, viewing the unfathomable depths of human passion, individuality, creativity, curiosity, reason, intuition, will, compassion and spiritual insight as mere secretions of the brain, akin to the way the kidneys secrete urine."

Similarly off the established path, a British child psychiatrist warns against labeling, and treating, the increasing unhappiness among children as depression.

"Recent evidence has suggested that selective serotonin reuptake inhibitors (anti-depressants used to treat the disorder) are largely ineffective and may be dangerous in this age group," Simi Timimi wrote in a leading medical journal.

"Older antidepressants have already been shown to have no beneficial effect in people under 18. So how did we get into this mess?" she wrote. "Undoubtedly part of the problem is with pharmaceutical industry tactics, designed to enable greater consumption of their products."

In addition, shifts in Western culture have pushed more childhood behaviors into the realm of medical problems, she claims, calling for a refocusing on the underlying reasons for youths' slip into sadness.

Skeptics like consumer-rights advocate Barbara Loe Fisher are even less circumspect in their criticism.

"(T)he medicating of our children for everything from 'depression' to hyperactivity without getting at the root cause for the behavior disorder or the autoimmune disorder (asthma) or the neurodevelopmental delay (autism and learning disabilities) is not going to lead to better individual or public health," Fisher said.

She is co-founder and president of America's largest and oldest vaccine safety and consumer watchdog organization, the National Vaccine Information Center in Vienna, Va., and co-author of "DPT: A Shot in the Dark" (Harcourt Brace Jovanovich, 1985). Fisher has served on the National Vaccine Advisory Committee, the Institute of Medicine Vaccine Safety Forum and the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee.

"Pharmaceuticals only act as a Band-Aid to stop the bleeding temporarily," she maintained. "Becoming dependent upon drugs and vaccines is not the answer to the open wound that has been created by failed health policies which do not approach health wholistically."

On the mainstream side of the debate, most mental-health providers swear by the medicines, which they see as boosters, not busters, of psychological wellbeing.

"I don't think anyone who's been able to treat depressed patients will tell you SSRIs and Prozac didn't result in dramatic improvement," said investigator Donna Palumbo.

She is associate professor of neurology and pediatrics, director of the Strong Neurology ADHD Program and head of pediatric neuropsychology training at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.

"We didn't have anything effective before SSRIs," she said. "These are drugs, and drugs will have side effects. Nothing is foolproof. But do you throw the baby out with the bathwater? What of all the people that dramatically were helped by the treatment?"

Palumbo acknowledges the medicines come with side effects but insists the risks are outweighed by the benefits.

"I can't say of those thousands of children we've treated, we haven't had horror stories. I've had children develop side effects, and they've had to come off the drugs, but we've had much more successes," Palumbo said. "Some of these children are so out of control or struggling (so much), it's heartbreaking when you know they're bright and can do better if they're not in the trenches."

Go To Good Drug Guide
Rank theory
Pain and rejection
A Pill For Every Ill?
Is depression adaptive?
The Pursuit of Happiness
The Abolition of Depression
Children and Antidepressants
An Evolutionary Approach to Mood Disorders
Drug companies and the Marketing of Depression