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By Dennis P. Cantwell M.D., Gabrielle A. Carlson M.D. (auth.)

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The familial pure depression group describes patients who have a family history of depressive disorder only. Depression spectrum disorder describes those patients with a family history of other psychiatric disorders such as somatization disorder, antisocial personality, and alcoholism, which may occur alone or in combination with depression. The validity of the primary-secondary, bipolar-unipolar, and the subdivisions of the unipolar types have been reviewed recently by Cantwell and Carlson (1979), Andreasen (1982), Schessler et al (1980), and Andreasen and Winokur (1979).

This group was found to be more common in older children (after age 11), when the last stage of piagetian thinking was just beginning. " Fifteen depressive items were selected on the basis of clinical frequence. The first five related to the affectual depression group, the second five to the negative self-esteem group, and the third five to the guilt depressive group. Other than differences in age, it is unknown whether outcome, association with other symptomatology or other psychiatric disorders, and response to different types of therapeutic intervention distinguished these three types of depression.

We have seen children who develop these "equivalents" secondary to their depression. We have also seen many children whose depressive symptoms postdate their conduct problems and/or encopresis. The temporal relationship of these "equivalents" to the course of the depression may be more important than simply their presence or absence. In this youngster, as in others we have seen, there is often a relative underactivity. It appears to this author, however, to be listlessness and lack of energy and to be less pervasive than the total system slowing seen in adult psychomotor retardation.

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