In 1987 I attended a lecture entitled "Does Depression Exist In Children?". We were coming out of the psychoanalytic era in which depression was seen as a complex study of intrapersonal conflicts. We had thought that depression couldn't occur because their personality structure was not mature enough to engage in depressive conflict. Well, anybody who has had a child with depression and suicidal thought knows that to think that depression is not possible in children is absurd. We in the field of child psychiatry have come a long way in 20 years. Or have we?
One concern is the issue of bipolar disorder. Sometimes when you see depression in children or adults it may be the initial onset of a cycling mood disorder. It is very important, therefore, to rule out the possability of early onset bipolar since the use of an antidepressant can have disasterous consequences. We rely on research to help give us guidance. Research is indicating that we have to suspect bipolarity when: 1) there is a family history of bipolar and 2) there are vegetative symptoms of depression (insomnia, decrease appetite, decrease in concentration, low energy, etc) in prepubertal kids. Other tip offs are: severely disrupted sleep patterns, psychosis, atypical depression (sleeping too much and eating too much), adverse responses to antidepressants or stimulants, etc.
What is a challenge is putting the pieces of the puzzle together in order to make sense of it all.