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The Depressed Child and Adolescent.
  1. JOHN HIGGS, Consultant child psychiatrist

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    The Depressed Child and Adolescent. Edited by Ian M Goodyer. (Pp 354; £45 hardback.) Cambridge University Press, 1995. ISBN 9-521-43326-6 .

    I am a busy child psychiatrist and I suspect, like many others in my position, find the time for reading squeezed by ‘post NHS fatigue syndrome’. Depression in children, as the editor of the book comments, is not easily evaluated and difficult to treat. For these reasons I looked to this book for clear narrative, a review of current information, and new ideas.

    This is the first in a series of Cambridge Monographs in child and adolescent psychiatry designed to cover major syndromes affecting children’s mental health. What is different about this series is its emphasis on the effect of normal and abnormal child development on depressive syndromes. There are contributors from both sides of the Atlantic, clinicians and researchers.

    The book opens with an historic review which nicely sets the scene for society’s development in appreciating childhood depression. Subsequent chapters then review normal development of emotional regulation and physiological changes with age. There are sections on classification, genetics, social and physiological aspects of morbidity and suicidal behaviour. The reviews on treatment consider the child’s developmental stage influencing response to treatment; for example, cognitive behavioural therapy, even in the adolescent, may be limited in those individuals who cannot engage in logical reasoning.

    The book is rounded off with a review of the natural history of depressive disorder in the young. The concept of scarring by a first episode is mentioned, hopefully justifying adequate child psychiatry services. If we can help these patients overcome their first episode of depression, further episodes need not be so devastating.

    The book has several strengths. Firstly the contributors are concise and, with some exceptions, their reviews are clearly written. Secondly the index and reference lists are comprehensive and the latter are usually cited from more accessible journals. Thirdly there are some really helpful clinical chapters. The chapter on drug treatment adds new ideas in an area where previous work has suggested it is of little help.

    The review on suicidal behaviour, from the department of paediatrics at Utrecht, gave a constructive approach to assessment. The chapter brings together the influences of abuse at different stages in the child’s life, influencing intervention. Perhaps they should have referred to the work of Moses Laufer1 who has also looked at the individual’s thinking in these situations with useful practical implications.

    Similarly the review of psychological treatments was limited by lack of discussion of psychoanalytic approaches, particularly in the treatment of chronically depressed youth with many social adversities and previous abuse.

    The main weakness of the book is that some reviewers tried to do too much in a short space. This was shown in the chapters devoted to neuroendocrine, physiological, and family genetic aspects. Some authors seemed bored by the effort of trying to squeeze complex and often conflicting material into short chapters. This was disappointing especially as some ideas are intriguing, such as neuroendocrine ‘scarring’ caused by repeated stress, for example, bullying. Part of the problem is lack of research in childhood depression, an area which has really only been recognised in the last 30 years or so.

    I am left with the impression that the book is not wholly successful in its stated purpose. This is because some chapters were confusing to the clinician and probably too brief to interest researchers in development and clinical neuroscience to whom the book is partly directed.

    I did come away with new ideas and information from the chapters of a more directly clinical orientation. I was even able to be one step ahead of some colleagues in a recent audit meeting looking at the management of childhood depression.

    The Depressed Child and Adolescent. Edited by Ian M Goodyer. (Pp 354; £45 hardback.) Cambridge University Press, 1995. ISBN 9-521-43326-6 .

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