Depression 103sleep. The symptom cluster of depression is not necessarily abnormal: it
can, for example, be a part of normal grief.
Depression as a disorder
When should someone with the symptom cluster of depression be de-
scribed as experiencing a depressive disorder? The criteria have become
less stringent over the past two decades, so that rates of diagnosed depres-
sion have risen dramatically. DSM-IV and the research version of ICD-10
both specify that symptoms must persist for at least two weeks to constitute
a depressive episode, and core symptoms have to be present for most of the
day for the majority of these days. Some definitions state that a disorder is
only present if the depressive symptoms result in social incapacity as well
as distress: an additional criterion that has the advantage of sharpening
the distinction between normality and abnormality, but the disadvantage
of excluding children who manage to continue with their everyday lives
even though their depressive symptoms cause them much suffering. Some
children and adolescents who do not meet the full diagnostic criteria for
a depressive disorder do have depressive symptoms as part of a relatively
undifferentiated emotional disorder that also involves symptoms of anxi-
ety, fearfulness or obsession. Such undifferentiated disorders are common
but are not well handled by the current diagnostic systems. By convention,
depressive disorders are not diagnosed if an individual also meets criteria
for schizophrenia.
Features of depression at different ages
Children under 5 who are separated from their attachment figures will
often go through a phase of despair, but it is unclear whether this despair
is equivalent to depression. From roughly the age of 8, however, some
children do experience depressive disorders that are phenomenologically
very similar to adult depressive disorders. This similarity enables depressive
disorders to be diagnosed in children and adolescents using unmodified
(or only slightly modified) adult criteria. Sleep and appetite disturbance
seem less common than in adults. Guilt and hopelessness are probably less
common in depressed children than in depressed adolescents and adults
(perhaps reflecting the cognitive sophistication needed to experience guilt
or hopelessness). The suicidal plans of depressed children are typically less
lethal than the plans of depressed adolescents or adults. For example,
depressed children may try to drown themselves by putting their head
under water in the bath. The constellation of depressive symptoms may
include refusal or reluctance to attend school, irritability, abdominal pain
and headache. Indeed, somatic complaints should always be asked about;