When I was 3 years old I had generalized anxiety disorder and separation anxiety disorder and I was at my most anxious at 3 and 4. Mental health issues during pre school years is very real because that's when it was most intense for me. At 3 years old I had a lot of anxiety and was already thinking like an adult, worrying about all sorts of stuff, so I believe that child mental health issues are very real. Depression might be different, but childhood anxiety disorders are real. I was crying a lot and was an emotional and vulnerable three year old. My first therapy session I had when I was 3, it was called play therapy, but I didn't understand it because I was so young.

It's not as if 3 year olds can't be abused and traumatized so yes, I believe they can be sad, depressed, unhappy, whatever you choose to call it -- does that mean they have to be labeled with a disorder and medicated? God I hope not. I certainly wouldn't expect any kid in his right mind to be playful in the face of each and every set of circumstances this world can throw at him but does that mean he has a chemical imbalance? Please spare me. Certainly at this age one should be able to define and isolate exactly what's going on in the environment that led to the symptoms. And maybe do something constructive about it.

I was an anxious three year old too - in 1954. There was therapy but no drugs...I agree completely with Sara. If a young child is that upset, there MUST be something environmental that can change before giving brain damaging chemicals to suppress the tears and fears. Poor little kids.

Few things disgust me more than the drugging of children. I wouldn't be surprised if the DSM V includes the terrible 2's as a psychiatric disorder. And I agree, the AP should know better than to spread that brain imbalance bull crap around!

On a side note: This morning the Today Show covered the story about the increase of anti-depressant use in the US. It was somewhat balanced, but they only briefly touched on anti-depressants and suicidal ideation.

Yep, with no evidence at all, the chemical imbalance theory is treated as an established fact in the mainstream media, but then 10 years ago I thought it was an established fact. I think the word is getting out though this nonsensical bit is discouraging and does weaken my argument. Unhappy children have defective brains, please!

What really bugs me about the child depression (bogus) paradigm is the fact that all children experience separation anxiety, for gods sake even animals experience separation anxieties and nervousness when they are being ill treated, ill nurtured or not getting their needs met. These are not mental illnesses people, these are emotions....The range of human emotions, moods and experiences that children (and adults) go through are completely natural. It's the human condition folks and like it or lump it we are stuck with it....

I've just remember that 4 years-old child who died after being two years in many psych-drugs but I cannot find the article.
They will continue to drug children: bipolar child, hyperactive, depressed... many labels.
This is criminal, inhuman and physicians who give drugs to children are also to blame.
I will no longer be sympathetic with psychiatrists.
I'm not anti-psychiatry but those who are changing people's lives and destroying children's body...
Jesus it's appalling.

Ridiculous! Big Pharma's intended consumer base just keeps getting huger and huger. We'll have to hit a critical mass at some point (perhaps when 50% or more of the population is deemed chemically imbalanced) and then hopefully common sense and skepticism will prevail.

I'm not really surprised at the AP's faith in chemical imbalances. That is what doctors and advertisements preach. But what does surprise me is psychiatry's lack of shame in the fact that there STILL exists no testing for any of these imbalances. What other branch of medicine would be allowed to continue?

One out of four women in the US are molested before the age of 18 (cf Diana Russell, et al). This doesn't address male abusees or physical and psychological abuse. So yeah, I'm sure there are a LOT of unhappy little kids in the world.

I was a failure to thrive baby, weighed 12 pounds at the age of one, 25 pounds at aged five. I was also being molested by my mother, handed over to an uncle, beaten and--hello?--starved. Not one adult ever questioned why I disappeared for two months at aged 7 when I was locked in a closet in a prolonged attempt at starving me to death. This has all been confirmed by my perpetrator and by school absence records.

Don't anyone talk to me about "brain imbalances" in children. Or adults, for that matter. Do your homework first. Sheesh.

I'm off to let the chickens out and walk the dogs before I haul my atheist arse out the door to my job as (believe it or not) a church secretary. Life is full of little ironies, ain't it?
Sherry (who just got back from a wonderful vacation in Maine so even articles like this can't spoil her mood, thank you)

I agree that this "brain disorder" medication bias is sick. I blogged on this yesterday:
http://www.medsvstherapy.com/2009/08/this-story-makes-me-sick-and-mad-kids.html

My main outrage is that the news story has absolutely NO mention of environmental influece - no mention of busy/absent parents, harsh parents, etc. I am sure that a child is born here or there, extrememly rarely, with a mood disorder, biologically influenced, despite the best of parenting practices. Nonetheless, if you have an overly worried or depressed child, you should first investigate the parenting, and social context. Is a divorce going on? Parent financial problems? Marital discord? Geographic move? What happens when the child needs discipline? Who cares for the child weekdays, weenights, weekends?

The story includes none of this.

I also made the point that animals can experience similar things, and that this problem in animals would make it more clear to us that environmental influences were more significant.

I think the point also needs to be made that not ALL depression, anxiety, fearfulness, moodiness is ALWAYS associated with poor parenting, trauma, chaotic environments. Sherry's story sounds horrifying and of course there will be emotional fall out. But that fortunately doesn't happen to most kids who are depressed.

The question is what to do when problems in kids are evident and there isn't an obvious stressor to account for it - what then? Would you keep digging around in the families life until you found the stressor? What's the least significant stressor you would consider the cause of a preschoolers depression?

Yes, emotions are normal and we all have them all the time: kids with greater frequency and intensity. What the researchers are talking about is when those emotions don't subside and the kid can't be helped into a better frame of mind. All kids throw tantrums and most return to the same goofy and sweet kid when its over. Its not a mood problem until those tantrums or dark thoughts last longer with no break.

At some point we have to acknowledge that some of these disorders are rooted in a biological cause. The hard part is knowing what that cause is and what to do about it. You can't completely debunk the biological or chemical basis of behavior or psychiatric conditions. We don't have any thoughts without a chemical reaction of some sort. Neuroimaging studies can document changes in the brain associated with God and religious belief.

I'm going to come right out and say what is intuitively obvious to any serious student of human behavior: 3-year old children "with otherwise happy" lives are not chronically depressed, in the true clinical sense. That is just self-promoting bullshit. If there are perceived mood or behavioral problems in these children, you need to dig a little deeper into their home environments. I would not hesitate to wager a few months' salary on the eventual discovery of familial or environmental dysfunction (or an actual physical ailment). I find it interesting that mood chronicity can be identified in the brain of young human children - in what is supposed to be its most formative, malleable stage of development. Does a cranky 3-year old inevitably become a suicidally depressed adolescent? If antidepressants are dangerous to adolescents because their brains are not as fully developed as those of adults, how does one address perceived chronic depression in a 3 year old? I think the logic is as flawed as the science.

"At some point we have to acknowledge that some of these disorders are rooted in a biological cause."

Even if it's correct there is no drug in the market that can treat it.

"Neuroimaging studies can document changes in the brain associated with God and religious belief."

And so what?
Just because a region is activated because of one reason it does not mean that this is the cause of the disease. It can be just another of many signs that are still to be discovered in the brain or the body that are still far to be understood.
Serotonine for instance is not only responsible for brain activities. It regulates other body activities.

This is what is being sold to the public:
"See? We understand the brain now with these colors we have."

Nothing has changed of what is known from the brain in the last decades and it's a shame that researchers and physicians make people believe that a huge advance in understanding the diseases was done.
We are still at the beginning of a long road and we don't have a clue which path to take and where will it leads.

I agree with Craig in that there are going to be biological predispositions in individuals - humans and other mammals - that will express themselves in ways that may or may not have clinical significance. My question is - who gets to define what is "clinically significant" and on what evidence will that assignment of disease be based? What may be deemed a "clinical condition" in one setting may be a reasonable and useful adaptation in another. I just think its dangerous to make a sweeping statement about chronic mood disorders in developing children.
I can't help but suspect that it is merely manufacturing a need for a pharmacologic intervention. Once it becomes acceptable to bathe young brains in powerful psychoactive drugs, will we start hearing about pre-natal mood disorders? I've learned you can never underestimate the will of pharma to identify new patient populations.

Something that seems to be getting lost in all this is the matter of consent. Children do not have informed consent. Even if you informed them you would be a fool to think they are able to process all the factors involved, the risks, short term or long term and come to a meaningful, well considered judgment on the matter.

The short term hysteria is (or will be)"Let's treat these poor children now before anyone thinks too hard about it!"

The long term effects that include in some people both sexual impotence and inability to form affection attachments or love are a result of all the other things serotonin does to the body that these neuroscientists do not understand when they gave you a pill that would selectively inhibit reuptake.

Most adults have the ability to think about the pros and cons in a meaningful way. As informed adults making decisions about what they put in their own body they choose consent and accept the possibility and responsibility of side effects.

When an adult loses their sex drive and wants off the meds and can't immediately discontinue due to awful withdrawal pains that adult understands they consented voluntarily.

What happens when that three year old becomes a fifteen year old who is supposed to be fapping and flirting can't because they've been on SSRIs since they were three?

Now they want off and tell their parents they are stopping meds starting now and their parents flip out screaming:

"No you can't! You might die or become psychotic or suicidal!"

Now the teenager has only two questions.

What have you done to me?
and
Why have you done this to me?

Faced with essentially serotonin addiction and being unnecessarily overweight and impotent an informed fifteen year old can legally refuse has right of consent to refuse consent.

A child does not. A three year old can not refuse. Imagine the blackmail as Mom tell junior he can't have jello after dinner until he opens up and swallows the medicine like a good boy who wants to make Mummy happy and proud.

Get him trained like Pavlov's dogs to pony up for meds voluntarily at the sound of the dinner bell. Showing Mom how mature he is now, taking the meds all by himself like a big boy.

There is nothing remotely like informed consent going on here. This is coercion. You don't tell your three year old that it's going to prevent them from playing with themselves. You just give it to them. You want to feel better don't you? Atta boy.

Parents are free to make up any story they want but all they need is pharmaganda. Why do I have to take a pill that might make me fat Mom? Because you have a chemical imbalance darling!

Kid mulls all this over. Ten years later he is on Youtube making comments slamming all the SSRI nightmare videos that without antidepressants he would be D E A D by now! How does he know? That's what the parents told him.

Kid never even knows if he actually had clinical depression at three. Too scared of withdrawal from all the crap his parents told him would happen if he tried secretly to go off them without telling them.

Even if he did get off them he would not know how to handle the normal feelings of depression that every day teens go through as part of puberty and life. He's been gimped by drugs and has no coping mechanism when real depression finally strikes.

Unable to deal with the torrent of spiraling emotion he grabs the only thing he knows which will make it go away. Somewhere a pharma accountant smiles as another lifer comes back to the fold.

The parents breathe a sigh of relief. For a moment they almost had to do some real parenting. Now they can get back to reality TV and nom on kettle chips.

Meanwhile the SSRI inhibitors rescramble his already scrambled neurotransmitter pathways. As he ties the rope around his neck he briefly wonders if it is the drug that makes him feel this way or the absolute lack of control over his life, his body his own brain chemistry that is causing this impulse.

Dear Craig,
"Sherry's story sounds horrifying and of course there will be emotional fall out. But that fortunately doesn't happen to most kids who are depressed."

And you know this how? You apparently missed the part where I said "Not one adult ever questioned why I disappeared for two months at aged 7..." Did you think I was exaggerating? Lying? Mistaken? Or did you simply gloss over this astonishing fact?

You went on to say: "The question is what to do when problems in kids are evident and there isn't an obvious stressor to account for it - what then?"

I repeat: there WAS no OBVIOUS stressor in my life or in my family. My mother was a very bright sadistic sociopath. Her family were alcoholics who helped cover it up. My cousins were all molested as toddlers, beaten frequently. One of them became brain damaged because his parents were too self absorbed to bother to give him an aspirin and his brain was literally cooked.

NONE of this was ever noticed or obvious to neighbours, teachers, priests (oops, they were pretty busy themselves...). Do not fool yourself that "things have changed" in the area of child abuse. That's garbage people tell themselves so we don't have to deal with it.

You missed the very point of my story, which is: You do NOT know what goes on behind closed doors.

When a very young child is seriously depressed the sound you're hearing is probably the hoofs beats of abuse or neglect, not the zebra of "brain imbalance." That's one out of four women, Craig, one out of four. That's a LOT of former small children.

Paugh. Why do I friggin' bother?

Sherry,

I hope you keep bothering.

Somebody raised the point that not all children who suffer from depression have suffered trauma ....

Good Point..

But also, surely these kinds could just be sensitive? ..

And if so, what's wrong with that?..

Since when did sensitivity become a "mental illness" ???

Sherry - I wasn't trying to offend you or minimize your history. I do hope you keep bothering and apologize for any misunderstanding. I am very aware of the terrible things done to children everyday and very troubled by it and realize that much of it goes unnoticed. The last thing I wanted to do was cause you any additional headaches.

I was just trying to point out that severe abuse is probably less common than depression may be and that depression at any age might not always be a reaction to a traumatic event. I think depressions that are unprovoked probably have a different cause than those that are provoked. The issue for me then becomes what counts as being provoked or not. Truthman raises a good point. I wouldn't say sensitivity is a mental illness but it could place kids at risk for problems down the road.

Almost any kid who gets a goldfish will have the goldfish die on them. What distinguishes those who are sad for a while but snap out of it from those who ruminate on it for weeks, have guilt, cry, can't sleep, don't want to do anything fun, don't want to eat, etc.

Not trying to equate the goldfish with real trauma - it's just those types of depression that I can't wrap my head around.

Sally,
Thanks. I needed that.

Craig,
While I certainly agree that not all depression is caused by trauma, I do believe most of it is. There are many kinds of trauma, for starters. And the daily drip, drip, drip of parental disapproval or disinterest can be much more corrosive and depression inducing than severe episodic trauma.

Your statement that "severe abuse is probably less common than depression may be" implies that somehow you can actually KNOW what goes on behind closed doors, that you somehow can reliably assess whether a child's depression is warranted or not. Who elected you judge and jury? Do you have some sort of special powers that enable you to know what others cannot? X-ray vision, perhaps?

My point, which you still do not seem to get, is precisely that you can NOT EVER know that a depression is "unprovoked." How very arrogant and dangerous of you to even consider you have such power, that you have the authority or ability to sit in judgment of another human being's emotions, to deem them "provoked" enough to suit you.

My point is that you would have totally missed what was going on in our home, just as all the other doctors, teachers, neighbours and other adults in our lives missed it. I grew up in a home where incest was so tolerated it was joked about.

But not in front of someone like you. You would have been shown another face entirely. And you would have swallowed it hook, line and sinker while they laughed their butts off at you behind your back.

And, worst of all, if you had prescribing powers you would have *helped* them in their abuse. You would have been integrated into their activities, congratulating yourself all the while. That's what the Rebecca Riley case is all about, sir.

That's really why I bother, although I suspect your arrogance won't allow you to hear how helpless you really are in these situations. The danger of medicating children into further silence who need real help far outweighs the chance that some "brain imbalance" we cannot measure might exist.

Let's be honest here folks...

I have experienced depression on and off during various stages of my life, it is a beast I know well...

I know I am a sensitive person, perhaps more sensitive than I or anyone else realized as a child ...

The society we live in today, in the western world particularly, does not value, respect or cherish sensitivity in children or in adults for that matter ..

People are encouraged from a very young age nowadays to perform constantly , not to be weak and to be extremely competitive from the cradle to the grave...

We were not made to withstand such an barrage of advertising, constant media manipulation and a society that borders on being completely out of control...

It is unsettling and unfortunate that we have a very powerful and grossly pharmaceutically funded organization like psychiatry that preys on the very vulnerabilities and sensitivities that exist in children and uses these human experiences as fodder for pharmaceutical profit...

100 years ago, mental illnesses were confined to the criminally insane in morbid, dark and inhumane asylums...

The whole world has become a bit of a mad house, and psychiatry is exploiting that ...

People will always experience fear, sensitivity, guilt, shame, nerves, agonizing soul searching, grief, melancholy and sadness...

These are human emotions, not psychiatric illnesses, they should be respected as such and no child should be labeled with a "mental illness" , it is abhorrent and cruel to do so...

Nice blog you have here Philip. I've been reading for a while and this was the first time I contributed any comments. Try to politely bring up an opposing point of view - even apologize when you think you might have inadvertently upset someone - and get sarcastic name calling in return. I like a good argument, but don't have the stomach for further tweaking Sherry.

Craig,
I see you've still missed the point. Good change of subject, though. Very adroit.