Managing depression in childhood and adolescence

This paper describes depression (a syndrome of low mood/irritability/lack of pleasure with associated physical and cognitive symptoms) in children and adolescents. It aims to help GPs to recognise more cases of it. It discusses why some young people do become depressed and will describe the treatments which are available, and how treatment may be implemented in the primary care setting. Current UK NICE guidelines recommend that: (i) psychological treatments should be offered as first-line treatment for moderate to severe depression and persistent mild depression; (ii) if this is not effective after four to six sessions, co-existing factors such as social stresses and family discord should be considered and addressed; (iii) an antidepressant (fluoxetine) should only be considered after four to six sessions; (iv) antidepressants should only be offered in conjunction with psychological treatment. These guidelines are not in full agreement with large randomised controlled trials that demonstrate that fluoxetine is more effective than CBT; and that show equivocal benefit of combined fluoxetine and CBT over fluoxetine alone. Part of the reason for the predominance of psychological treatments in these guidelines is the small but significant risk of suicidality with fluoxetine.