Depression in preschoolers is chronic and recurrent

Child psychiatry researchers have found that preschoolers don’t outgrow depression, and depression in a 3-year-old doesn’t turn into something different by the time that child is 5.

Following more than 200 preschoolers for two years, a team led by Joan L. Luby, M.D., professor of child psychiatry, found that preschoolers diagnosed with depression at their initial examination were four times more likely to have depression 12 or 24 months later than those who were not depressed when the study began.

Joan Luby


A total of 75 preschoolers were diagnosed with depression at the start of the study. Those kids were examined at six-month intervals for the remainder of the study period. At the six-month follow-up, 64 percent were still depressed, and 40 percent were depressed at 24 months.

“When you’re depressed as a preschooler, it’s not just a transient, developmental blip that’s going to spontaneously go away,” Luby said. “And it’s not a nonspecific precursor of some later problem. It appears to remain true to form — or to manifest a phenomenon called homotypic continuity — in that it continues to be depression across time.”

Preschoolers with depression are sad, have low energy and suffer with anhedonia, the inability to enjoy life. Luby said their symptoms appear as age-adjusted versions of the symptoms seen in older children and adults.

And like older children and adults, preschoolers with depression tend to have chronic and recurring problems with the disorder. Luby, director of WUSTL’s Early Emotional Development Program, said the good news is that identifying depression in very young children may make it possible to begin treatment earlier and perhaps change outcomes.

“Many disorders, and mental disorders in particular, are more treatable when the brain is more changeable and neuroplastic,” she said. “We’re hopeful that by identifying depression early, we may have more success treating it.”

But the new study, reported in the August issue of the Archives of General Psychiatry, did not address how to treat depression in preschoolers.

“The study makes absolutely no statements about treatment,” Luby said.

“We definitely do not recommend treatment with antidepressants because there is no evidence that they are either safe or effective in very young children. Instead, we currently are investigating a dyadic play therapy involving children and their caregivers to learn whether the emotional support such therapy delivers might improve symptoms of depression in preschoolers,” Luby said.

Luby said early results of the investigational play therapy look promising, but they await findings from their ongoing study.

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