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Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2005

Pharmacological and physical treatment of depression in children and young people

In the absence, until relatively recently, of good quality controlled trials of pharmacological treatments in children and young people, treatment practice has relied on extrapolation from the results of studies on adults. The mainstay of pharmacological treatment has been antidepressant drugs, initially tricyclic antidepressants and more recently selective serotonin reuptake inhibitors (SSRIs) and other atypical antidepressants. The herbal preparation, St John's wort, has been used for centuries for medicinal purposes including the treatment of depression, but little is known about its use in children and young people. Other drugs such as lithium salts and antipsychotics have been tried but their use is rare and usually reserved for young people with severe, psychotic and chronic depression. Lithium has also been used to prevent relapse of depression.

Summary of recommendations

When assessing a child or young person with depression, healthcare professionals should routinely consider, and record in the patient's notes, potential comorbidities, and the social, educational and family context for the patient and family members, including the quality of interpersonal relationships, both between the patient and other family members and with their friends and peers.

Depression

This guideline is concerned with the identification, treatment and management of depression in children and young people (from 5 to their 18th birthday in primary, community and secondary care. This guidance only relates to those conditions identified by the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (World Health Organization, 1992), namely, depressive episode (F32), recurrent depressive episode (F33), although some recommendations will also apply to dysthymia (F34.1). Much of this guideline is drawn from research that has utilised a similar, but not identical, classificatory system – the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) (APA, 1994). Other related NICE guidelines include depression in adults and older adults (NICE, 2004), and bipolar disorder in children, young people and adults (NICE, forthcoming 2006).

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