The Many Faces of Depression in Children and Adolescents

The Many Faces of
Depression in Children and Adolescents

David Shaffer, F.R.C.P.(Lond),
Bruce D. Waslick, M.D.

Depression Children and Adolescents: The authors have worked to ensure that all information in this book
concerning drug dosages, schedules, and routes of administration is accurate as
of the time of publication and consistent with standards set by the U.S. Food and
Drug Administration and the general medical community. As medical research
and practice advance, however, therapeutic standards may change. For this
reason and because human and mechanical errors sometimes occur, we
recommend that readers follow the advice of a physician who is directly involved
in their care or the care of a member of their family. Depression Children and Adolescents: A product’s current package
insert should be consulted for full prescribing and safety information.
Books published by American Psychiatric Publishing, Inc., represent the views
and opinions of the individual authors and do not necessarily represent the
policies and opinions of APPI or the American Psychiatric Association.

There is a growing literature describing the stress–vulnerability model of illness, a model applicable to many, if not most, psychiatric disorders and to physical illness as well. Vulnerability
comes in a number of forms. Genetic predisposition to specific
conditions may arise as a result of spontaneous mutations, or it
may be transmitted intergenerationally in family pedigrees.
Secondary types of vulnerability may involve susceptibility to
disease caused by the weakened resistance that accompanies
malnutrition, immunocompromised states, and other conditions.
In most of these models of illness, vulnerability consists of a necessary but not sufficient precondition; if specific stresses are avoided, or if they are encountered but offset by adequate protective factors, the disease does not manifest itself and the vulnerability may never be recognized. Conversely, there is increasing recognition of the role of stress as a precipitant of frank illness in

vulnerable individuals and of the complex and subtle interactions among the environment, emotions, and neurodevelopmental, metabolic, and physiological processes.
In this country, the years 2001 and 2002 contained the stress of
unprecedented proportions, with the terrorist attacks on September 11 and the events that followed that terrible day. Although the contents of Volume 21 of the Review of Psychiatry were well
established by that date and much of the text had already been
written, we could not introduce this volume without thinking
about the relevance of this unanticipated, widespread stress to
the topics already planned.

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