Depressive Illness in Children—a Review

True or pure depressions as seen in adult are very rare in children. However, recently, there have been many reports from various psychiatric clinics about childhood depressions and it has been more or less accepted as a clinical entity though not yet included in official classification. Historically sadness or despondency in children was recognised in the 17th century and suicide and melancholia were noted in children by the middle of 19th century. Manic depressive psychoses was reported in children only in early part of 20th century. Kraepelin (1921) reported that in a sample of 900 patients 0.4% had their attack of manic depressive episode before the age of 10 years. Barrett (1931) found that the onset of manic depressive illness in earlier years was more frequent than what had been thought of by others. Of 100 cases of manic depressive psychoses under 20 years, 5% had their 1st attack before the age of 12 years. Bradley (1937) felt that true depression does not occur in childhood and that manic depressive psychoses is very rare and of questionable existence before puberty. Kanncr (1948) also felt that full fledged depressive illness seen in adults is very rare in children. Campbell (1952) studied 18 children (11 girls and 7 boys) with manic depressive psychoses over a period of 2 to 6 years and emphasised the frequency and importance of this psychosis among children, the strong familial tendency of the disease, the reversible nature of the mental illness and the overemphasis that has been placed on environmental and dynamic factors in the psychiatric illness of children. He felt that cyclothymic personality and manic depressive psychoses among children are too often diagnosed as psychon euros is or schizophrenia or the patients are classified as problem children. Depression in infancy was noted as an effect of deprivation by Levy (1937). He studied a group of children who in their earliest years had received little or no maternal love and found that their affect was shallow and that they shared various neurotic symptoms. Levy described them as suffering from affect hunger due to deficient social relationship and they showed persistent relationship difficulties such as delinquent behaviour. Subsequently Spitz & Wolf (1946) observed a special condition in the nursery and described it as "anaclitic depression". This occurred in infants and small children who were isolated from maternal care. Such infants in the 2nd half of 1st year of …