Leading article: The misery of childhood depression

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That is about 180,000 young people whose lives are blighted by hopelessness, despair and a lack of self worth. No other illness of childhood comes close in terms of the numbers affected or the damage caused. And this is not merely a question of teenage moodiness. All young people have ups and downs, but depression is of a different order. It is persistent, debilitating, undermines schoolwork and leads to the loss of friends and the breakdown of family relationships. In the worst cases it destroys lives by suicide. Nor is it something children grow out of, although many will, thankfully, come through unscathed.

According to Professor Peter Fonagy, who chaired the Nice panel, depression scars children for life, both psychologically and physiologically. Subsequent setbacks in later life - divorce, bereavement - are more likely to trigger a recurrence of depression.

One in three of those affected in childhood suffer repeat episodes. Intervening early provides the best hope of breaking this cycle. But what is the best way to intervene? Too many GPs still reach for the prescription pad when faced with a more-than-averagely gloomy adolescent. Nice's guidance on treating depression in children and young people, launched this week, sensibly focuses on simple advice and psychological treatments and relegates antidepressant drugs to a supporting role, to be used only when talking therapies fail. Psychological treatments may range from advice on sleep and exercise - a regular run is one of the most effective proven antidepressants - to individual cognitive therapy, group therapy or family therapy.

There is mounting evidence that such therapies are effective. When they fail it is usually because the therapy has been too short, infrequent or not intensive enough .

High-quality psychological treatment available promptly to all under-18s who need it would greatly reduce the toll of misery in childhood, with its long-term damaging consequences. But the shortage of therapists in the NHS means that hope remains a pipe dream. The Department of Health has pledged that 6,000 more therapists will be trained over the next five years for the NHS. More are needed but if they are to have maximum impact, children must be first in the queue for treatment.

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