Treating Child and Adolescent Depression

Although professionals have recognized clinical depression in children and adolescents for the past 40 years, treatment research has only recently begun to identify promising treatment regimens. The editors of Treating Child and Adolescent Depression have successfully provided a comprehensive summary of the relevant evidence base related to childhood depression, translated into practical and easily digested information. While the book spans a broad range of topics, including epidemiology, types of depression, clinical course, etiology, risk factors, and effect of depression on functioning, the focus is clearly on assessment and treatment. This information presented is useful for a wide range of clinical, research, and lay audiences, including experienced mental health clinicians, general practitioners, students new to the field, or concerned parents.

Strengths include the comprehensive coverage of various treatment approaches (medication, biological approaches, cognitive behavioral therapy, interpersonal psychotherapy, family therapy, dynamic psychotherapy, and complementary and alternative approaches) as well as the treatment of youth with varying degrees of illness severity, comorbid disorders (eg, developmental disabilities, chronic illnesses, substance abuse, or other psychiatric diagnoses), and life circumstances (eg, histories of grief, trauma, or immigrant status).

The book presents far more than a cursory review. Detailed information is provided related to the conceptual basis for treatment, suitability for a specific child, techniques and details regarding treatment components, and recommendations for identifying and treating common obstacles or adverse effects. The book likewise provides evidenced-based advice related to the successful engagement of families into treatment, liaison with schools, management of adverse effects, treatment-resistant depression, specific types of crises and emergencies, treatment in primary care settings, and prevention. With chapter authors from Australia, Canada, New Zealand, Turkey, the United Kingdom, and the United States, international differences are highlighted. Eminently practical for teachers and clinicians, the book contains many helpful tables, decision trees, resource sections for families and clinicians, screening measures, examples of educational handouts, other clinical tools, and even specific dialogue in the sections describing cognitive behavioral therapy and interpersonal psychotherapy. Key points listed at the beginning of each chapter are detailed and valuable. The book is an excellent choice as a reference or textbook.

Given the extensive and careful review, it is unfortunate that the reader who has never experienced or witnessed an episode of major depression is unlikely to learn what it can be like for the depressed child or adolescent from a phenomenological or experiential perspective. Without direct experience, it is exceedingly difficult for most to translate the diagnostic criteria of depression to an understanding of emotional pain—pain sometimes so great that it can lead to a desire to end one's own life. Brief cases that include behavioral observations are provided in several chapters and are somewhat illustrative but do not capture the essence of depression from the first-person perspective. For clinicians to truly have empathy for their patients—and parents for their children—it is essential for them to understand how paralyzing, consuming, boring, painful, futile, and endless a depressive episode can feel. Only then is it possible to appreciate the degree to which depression can color the patient's perceptions and affect motivation and adherence to treatment.

While various approaches could be used to capture the essence of depression, the inclusion of brief quotes from depressed youth would be helpful for some readers; eg, “I can't remember what it is like to feel normal.” “Nothing is fun; everything is so hard.” “If the wooden beam in my bedroom ceiling fell on me and accidentally killed me, that would be okay. At least then I wouldn't be expected to go to school or do my homework. At least then I wouldn't be so mean to everyone. At least then I wouldn't lie awake in bed for hours, staring at the ceiling, and the beam. It isn't that I want to be dead, but I do not want to live like this.” Maybe I do want to be dead. No one understands how hard this is. This is too hard.”

While the omission of such quotes may not be relevant for some experienced clinicians or concerned parents, their inclusion would enhance the educational value of Treating Child and Adolescent Depression as a whole and could easily be added to future editions of this otherwise useful and highly recommended book.