Claire R. Holland, M.D., L.M.T.

There are many paths to healing

Brain Differences in Depressed Children

Children with pre-school onset major depressive disorder have smaller left and right anterior insula volumes compared with those without depression, suggesting insula function and structure may predict the risk of future depression. Results of the prospective longitudinal study were recently published online in JAMA Psychiatry.

One previous study found that the insula was smaller in depressed adults compared with adults who did not suffer from depression.  Another showed that children diagnosed with depression in preschool were 2.5 times more likely to be clinically depressed in elementary and middle school compared with children who were not depressed in preschool Researchers mentioned the insula is thought to be involved in emotion, perception, self-awareness, and cognitive function..

They diagnosed 47 children with depression as preschoolers, while 82 were not depressed. Of the children with depression, 55% had displayed pathological guilt compared with 20% of the children who were not depressed.

Pathological guilt can be a symptom of clinical depression, anxiety, obsessive-compulsive disorder, and bipolar disorder, according to Dr. Belden.

“A child with pathological guilt can walk into a room and see a broken lamp, for example, and even if the child didn’t break it, he or she will start apologizing,” he said. “Even after being told he or she is not at fault, the child will continue to apologize and feel bad.”

The researchers said they plan on following these students for at least five more years.

—Tim Casey


1. Belden A, Barch D, Oakberg T, et al. Anterior insula volume and guilt. JAMA Psychiatry. 2014; doi: 10.1001/jamapsychiatry.2014.1604.

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