Clinical Review

Managing and preventing depression in adolescents

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c209 (Published 22 January 2010) Cite this as: BMJ 2010;340:c209
  1. Anita Thapar, professor of child and adolescent psychiatry1,
  2. Stephan Collishaw, senior lecturer in developmental psychopathology1,
  3. Robert Potter, consultant child and adolescent psychiatrist 2,
  4. Ajay K Thapar, general practitioner3
  1. 1Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff CF14 4XN
  2. 2Trehafod Child and Family Clinic (Cwm Taf NHS Trust), Cockett, Swansea SA2 0GB
  3. 3Taff Riverside Practice, Riverside, Cardiff CF11 9SH
  1. Correspondence to: A Thapar thapar{at}cf.ac.uk

    Summary points

    • Depression affects 1-6% of adolescents each year worldwide

    • Diagnostic criteria for depression are the same as for adults, but the primary presenting concern may be different (for example, behavioural problems, refusal to go to school)

    • For mild depression, cognitive behavioural therapy seems to be effective. Because such treatment is a scarce resource, less specialised supportive treatment and guided self help can be used initially

    • For moderate-severe depression, fluoxetine and routine specialist (child and adolescent mental health service) clinical care or fluoxetine plus cognitive behavioural therapy is recommended

    • Suicidal risk must be carefully monitored

    • Parental depression needs to be treated

    Depressive disorder affects 1-6% of adolescents each year worldwide,1 2 and early onset heralds a more severe and persistent illness in adult life.3 Effective treatment is available, but best treatment practice is controversial because of concerns about the use of antidepressants in young people and inconsistencies in evidence. This review provides guidance for non-specialists on the assessment and management of adolescent unipolar depression and considers emerging evidence on prevention strategies.

    Sources and selection criteria

    We searched for papers published between 1990 and 2009 using key index terms (adolescent depression, treatment, and prevention) on PubMed (Medline and life science journals). In addition, we consulted the Institute of Medicine report “Preventing mental, emotional and behavioral disorders among young people: progress and possibilities” (published by National Academies Press 2009), NICE guidelines on adolescent depression, Cochrane systematic reviews, and BMJ Clinical Evidence. This was supplemented by reviews and our own knowledge.

    Why is it important to identify adolescent depression?

    Evidence from prospective community studies suggests that rates of underdiagnosis and undertreatment of depression are higher in adolescents than in adults.4 Large scale, longitudinal population based and clinical cohort studies have consistently shown that rates of depression rise sharply after puberty, especially in girls, with immediate and long term risks.5 6 Clinical depression …

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