Major Depression in Children and Adolescents

TREATMENT

For a favourable treatment outcome, early diagnosis and treatment with continued monitoring ought to occur. Psycho - education is an absolute for patient and family. Clinical experience suggests that such education enhances treatment compliance. The most efficacious treatment of depression in children and adolescents is the simultaneous use of pharmacotherapy and psychological therapies.

DRUG ASSISTED TREATMENT

The selective serotonin reuptake inhibitors (SSRIs) have now been shown in several randomised placebo controlled studies to be efficacious in the treatment of depression in children and adolescents. The studies show a response rate of approximately 60% with favourable side effect profiles and limited toxicity. Based on these findings, it is now considered that the SSRIs (see Table 4) be the first course of treatment for mood disorders in children and adolescents, although in Australia the SSRIs are currently only approved for treatment of depression in adults. It has been suggested that treatment continue for one year followed by a monitored medication free trial coinciding with a period of minimal stress. If during this period the depressive symptoms return, pharmacotherapy should be recommenced.

COGNITIVE BEHAVIOURAL THERAPY

Cognitive behavioural therapy (CBT) is the most widely used psychological intervention, which may be individually or group administered. Its utility, however, is now being questioned. CBT has its premise upon depression arising in response to maladaptive thoughts and behaviours; CBT identifies, challenges and modifies these thoughts. This therapy is most effective in milder cases of depression. CBT ought not be the initial treatment if the depression is severe and there is a suicide risk. In limited studies, CBT has been shown to be helpful in the prevention of relapse and produces a more rapid and complete response to treatment when used with pharmacotherapy.

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