There is much controversy regarding the occurrence of major depressive disorder in prepubertal children. However, several studies in both the United States and Britain have suggested that depressive disorder does exist, although the frequency appears to be lower than in adolescents. There is endocrinological evidence, based on the hypersecretion of cortisol and an abnormal growth hormone response to insulin-induced hypoglycaemia, to suggest that children with major depressive disorder show similar endocrine abnormalities to those of adolescents and adults. However, the number of patients in these studies is small and clearly more thorough investigations must be undertaken before any conclusion may be reached.
Regarding the drug treatment of depression in children, there is so far a paucity of good clinical trials to show that antidepressants are effective. Several small studies suggest that daily doses of up to 5mg/kg of imipramine may be beneficial, but there is no data to show whether other types of antidepressant medication are effective. The side effects and toxicity of tricyclic antidepressants are legion and have been discussed in detail elsewhere. Undoubtedly the SSRIs should now be the drugs of first choice in the treatment of depression in children.
Manic disorders would appear to be extremely rare in young children and only single case reports have appeared in the clinical literature. They are more common in adolescence but not as frequent as among adults. Some authorities have argued that the extent of mania among adolescents is underestimated and that many patients have been misdiagnosed as schizophrenics. Regarding treatment, lithium would appear to be the drug of choice. Since children and adolescents appear to have a higher lithium renal clearance than adults, it is occasionally necessary to give the drug in a higher oral dose than would be usual for the adult. Apart from the possible detrimental effect of lithium on bone growth in children, the monitoring of the young patient should follow the same procedures as outlined for the adult.
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