Affective Disorders in Children and Adolescents with Special Emphasis on Depression

Abstract

That fantastic great old scholar of the seventeenth century, Robert Burton (who could rightly claim to be the first psychopathologist), set it down in Part I, Section III, Subsection IV, of his Anatomy of Melancholy ¹ that maids, virgins, nuns, barren women, and widows were especially prone to insomnia, troublesome sleep, dejection of mind, discontent, weariness, grieving, and weeping “without any manifest cause.” As matters are developing today, we might very well have needed to add children to his list of vulnerable individuals or, at any rate, if we are to maintain his sex bias, little girls. He would have been a little surprised that contemporary men also frequently succumb to this “brutish kind of dotage” from the effects, presumably, of “black bile” (or its modern neurochemical equivalent). At that time, children were not supposed to suffer from anything but mental deficiency, and it is only in the past century that they were deemed capable of developing psychopathology and only in the last couple of decades that they were judged to be depressed. It seems that as adults became more aware of children as individuals, they also became aware of the wide range of affective disorders that they could manifest. A worldwide interest has developed in childhood depression with three points of view predominating: that it did not exist except in the minds of certain overly sensitive clinicians who detected such affects in almost every patient; that it existed in different forms throughout childhood; and, finally, that it was a plausible hypothesis to be tested open-mindedly. Before one tested this hypothesis, it seemed important to define and limit the concept and thus not render it too inclusive. The need to look for it is critical to the prospect of finding it. Malmquist² reported that, although child patients may both look and behave in a depressed way, the diagnosis of depression is rarely entertained. One reason for this is that the diagnosis has often been omitted from standard psychiatric classifications. Thus, Malmquist has, himself, proposed a detailed classification for childhood depressions.