Diagnosis and management of depression in children and young people: summary of updated NICE guidanceBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h824 (Published 04 March 2015) Cite this as: BMJ 2015;350:h824
- Kathryn Hopkins, technical analyst1,
- Paul Crosland, health economist1,
- Nicole Elliott, associate director1,
- Susan Bewley, committee chair and professor in complex obstetrics2
- On behalf of the Clinical Guidelines Update Committee B
- 1Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester M1 4BT, UK
- 2Women’s Health Academic Centre, King’s College London, London, UK
- Correspondence to: K Hopkins
The bottom line
There is little clear evidence to favour one psychological therapy over another for the treatment of depression in children and young people. Clinicians should discuss this uncertainty when recommending treatments
For initial treatment of moderate to severe depression in young people (12-18 years), antidepressants and psychological therapy may be started concurrently as an alternative to offering a trial of psychological therapy first and starting antidepressants only if this trial is unsuccessful
Depression affects around 2.8% of children under the age of 13 and 5.6% of 13-18 year olds.1 Effective treatment is important because persistent depression is associated with serious complications, including poor school performance and social functioning,2 recurring depression in adulthood,3 and suicide.4 This article summarises recommendations from the updated National Institute for Health and Care Excellence (NICE) guideline on depression in children and young people.5 The update had a narrow remit—only recommendations on the choice of psychological therapy and the combination of antidepressant treatment with psychological therapy were considered.
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. Where the evidence was minimal, recommendations in the original guidance were based on the guideline development group’s experience and opinion of what constitutes good practice. Changes to the original recommendations were based on evidence from updated systematic reviews on clinical and cost effectiveness. Evidence levels for the recommendations are given in italic in square brackets.
Assessment and detection
When assessing a child or young person with depression, routinely consider and record in the patient’s notes potential comorbidities and the social, educational, and family context for the patient and family members. This information should include the quality of interpersonal relationships between the patient and other family members and between the patient and his or her friends and peers. [Based on the …