The authors of this review set out to provide a comprehensive, critical review of the clinically relevant literature concerning depression in Down syndrome (DS) focusing on epidemiology, potential risk factors, diagnosis, course characteristics and treatment. The search was carried out in January 2011 and excluded review articles not adding new information and single case reports. They found 390 articles, of which 30 were finally included.
They suggest that earlier suggestions of an increased prevalence of depression in DS compared to other causes of learning disability are not supported but the recent literature. Individuals with DS do show many vulnerabilities and are exposed to stressors which might lead to increased risk for the development of depression.
The authors identified several potential risk factors in specific to people with DS, for example the presence of smaller hippocampal volumes, changes in neurotransmitter systems, deficits in language and working memory, attachment behaviours and somatic disorders. The literature suggests that certain protective factors however may play a role in reducing vulnerability to depression.
Given that diagnosis of depression in DS is mainly based upon observable characteristics there is a suggestion that modified diagnostic criteria might be needed.
Several common treatments for depression are explored in the literature in their relation to treatment for people with DS, including antidepressants, electroconvulsive therapy and psychotherapy. Despite the suggestion that these treatments are as effective in people with DS as those in the general population, the authors point to some evidence of under treatment of depression in people with DS.
They conclude from the review that there remain important limitations to the current clinical knowledge of depression in DS and that future studies should include systematic evaluations of pharmaco-therapeutic and psychotherapeutic interventions.
Depression in Down Syndrome: A review of the literature, Walker J et al., in Research in Developmental Disabilities, 32, 5, 1432-1440