Affective disorders Depression

Depressive symptoms, often reactive to a loss or other life stress, are common in young children but the full-blown picture of depressive illness is rare before puberty. Somatic symptoms like anorexia, abdominal pain, or headaches are a frequent presentation.

The treatment of depression in this age group has become controversial; cases have been widely reported in which links were claimed between suicide and the prescription of antidepressant medication. The question has recently been reviewed by NICE (2005), and a 'stepped care' approach was recommended. Professionals in primary care are advised against the prescription of antidepres-sant medication; it is considered that they should concentrate on support and risk assessment. Only in moderate to severe depression is antidepressant medication (fluoxetine) recommended, and then only in specialist hands.

Bipolar affective disorder occasionally starts in childhood, with either depressive or manic episodes. Mania may be misdiagnosed as conduct disorder or hyperkinetic syndrome (see below).

Suicide in early childhood is rare but suicide in adolescents, especially males, is increasing.

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