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09 Mar 2010

Pediatric Dysthymia
Hi there doc,

Here''s hoping you''re doing well. I am recovering (slower that thought) from an abdominal op! But all''s well &  quiet on the home front. I just have a question for you. You mentioned to " Theendmyfriend"  ''s post that it is rare for young children to be diagnosed with depression.

My son had rheumatic fever last year. It manifested in his ganglia and he had sydeham''s chorea, which lasted 6 months. About 6 months after first being diagnosed (so when the chorea stopped), he had a major psychotic episode. He had to be taken to hospital and sedated.

We took him to a respected pediatric psychiatrist and after a long (and expensive) meeting. Diagnosed pediatric dysthymia in him. He was placed on a course of xoloft and had group therapy to help him deal with everything that happened.

My question then is what age/ why would pediatric dysthymia then manifest in children. And also, could dysthymia necessarily lead to bipolar/ major depression later in life? And also would pediatric dysthymia be cyclical in nature (like bipolar).

I must add that my son (now 10) has been fine since his course of little blue pills. No regression (it''s been nearly a year) so far and happy as can be (for a boy who has to drink penicillin 2x per day till he''s 21!)

Sorry for the long post, but it''s all your fault for piquing my interest like that! :P

Have a good day, dear doctor!

Answer 415 views

01 Jan 0001

Hello there, Piqued Wooman ! I know Tchaikowsky wrote an Opera called Pique Dame, but I doubt he was thinking of you rather than playing cards.

Notice I suggested it was relatively rare for young children to be DIAGNOSED as depressed. It is surely more common than gets diagnsed. Your son's story is uncommon and complex. Rheumatic fever is fortunately not as common as it once was, and Sydenham's Chorea also uncommon - we learn about it in medical school, but many doctors will not see a case. One wonders what medications he received for the rheumatic fever ( even antibiotics can cause psychotic reactions AND depressions, more than most docs realize ) and what meds for the Chorea.
There's a possibility they might have singly or in combination, contributed to the psychotic episode, and/or the depression.

Anyhow, Dysthymia is a relatively new concept ( of course, it needs a really old guy like me to see something that's been around for a decade or so, as "relatively recent" ! )- but it's not a mainstream. widely recognized disorder. I don't regularly hunt through the specialized child psychiatry literature, but I haven't come across good research into this condition, its treatment and especially the outcomes.

Someone would need to study a realy large number of kids with any such disorder to answer even a fairly simple question like "at what age does it usually start ?" I know of no reason to expect it to develop into Bipolar Disorder or major depression later in life, though it may increase slightly the risk of this. Many people have Dysthymia ( sometimes described as depression spread thin - never quite as severe as major Depression, but lasting longer ) for decades, without deveooping Bipolar Disorder, or even a major depression.
Its frustrating when there are questions like these and don't have the right research to answer them. Without research, a doc can only guess on the basis of his own knowledge and experience. But the right sort of research, involving many children and following them up over years, is very expensive, not usually funded by governments, and not receiving drug company research funds either.

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