Can Depression Start in Preschool?

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Depression affects as many as 350 million people worldwide; even beloved, Oscar-winning comedians are, unfortunately, not immune. But just how early can depression take hold? Some controversial new research, led by Washington University child psychiatrist Joan Luby, has found symptoms of the disorder in children as young as 3.

This new paper, published recently in the American Journal of Psychiatry, followed 246 young children ages 3 to 5 for six years. Luby and her colleagues found that the kids who were depressed in preschool were two and a half times more likely to exhibit symptoms of depression later in childhood, throughout elementary and middle school.

More study details, from HealthDay:

When the study began, 74 of the children were diagnosed with depression. Six years later, 79 of the children met the criteria for clinical depression, including about half of the 74 kids diagnosed with depression when the study began.

Meanwhile, just 24 percent of the 172 children who were not depressed as preschoolers went on to develop depression later.

But what could depression possibly look like in a 3-year-old? The key marker, Luby argued in a 2010 paper, is the “absence of joyfulness,” but other clues are excessive guilt, changes in sleep and appetite, and changes in activity level. But some psychologists are skeptical of the idea of preschool depression, because identifying the disorder in very young children requires some adjustments to the diagnostic criteria. Psychologist John M. Grogol wrote of Luby’s 2010 paper:

She argues, however, that we can’t use the adult criteria for depression, since some of those criteria wouldn’t make sense in a preschool child. A preschool child, for instance, can’t experience the loss of sexual pleasure, but they can experience a loss of enjoyment in ordinary child play activities.

It makes a sort of sense on the face of it, but seems to start leading us down a slippery-slope of “adjusting” symptom criteria until they bear little resemblance to the original disorder.

Grogol worries that this could lead to an overprescription of medication to very young children who might not already need it (a problem that’s already received a lot of attention). Kids on the autism spectrum, for example, may not be as outwardly “joyful” as the typical preschooler, Grogol writes. Still, in her latest paper, Luby argues that early intervention could save some of these young children from suffering through major depressive states later in life. Moreover, leaving aside the question of medication, she told HealthDay that there aren’t currently any “proven, effective” treatments at all for depression in preschoolers. It’s a heart-breaking concept, and, clearly, more research is needed.