Adolescent Depression

W hen I began practicing child and adolescent psychiatry, I didn't expect to be treating children with depression. Back then we didn't believe that young people had the sufficiently formed egos and the brain development to cause the kind of chemical imbalance that is at the root of clinical depression. Indeed, thirty years ago depression in adults was poorly understood—or even accepted. And if the public, and even the medical world, had a hard time accepting depression as a disease in adults, depression in children was even harder to believe. Now things have changed. We know depression exists in adolescents and, more rarely, in children, and in many ways it is clinically equivalent to the spiral of depression in adulthood. Happily, thirty years later we also have a better idea of how to treat it.

Adolescent depression is truly a public health problem, with more than two million teenagers in the United States alone suffering from the disorder. Whether they are entering middle school or finishing college, the pain of depression can seriously erode a person's capacity for joy and curiosity. At its worst, depression can lead to severe isolation during the period of your life where you're most expected to expand your knowledge base and overcome social and developmental hurdles. What's perhaps even more frightening is that young people have always been more at risk for suicide, and we know that adolescent depression all too frequently has a lethal outcome.

“Depressed” is one of the most overused words in the English language—especially by teenagers. I'm so depressed, they say—even when they mean they're just upset about something. Most of the teenagers who truly are depressed don't realize they have an actual disorder. Diagnosis drives treatment, and while we have some very effective treatments there is still much to learn.

We're so pleased to have this issue guest-edited by Dr. Graham Emslie, professor of Child Psychiatry at the University of Texas and one of the leading experts and researchers in the field. Dr. Emslie has provided us with a comprehensive, state-of-the-art review of the psychopharmacological treatment of child and adolescent depression from the leading researchers in our field. Thank you to all who contributed. The problem of childhood and adolescent depression is real, and this work is helping to save young people's lives.