How should I approach the management of mild to moderate depression in a young patient?

For children and young people with mild depression, consider watchful waiting if the person and/or their family do not want a formal intervention and the healthcare professional believes they may recover without treatment. Arrange a follow-up after 2 weeks to reassess the patient. Contact children and young people who do not attend follow-up appointments. If depression persists after watchful waiting, offer psychological intervention, which should be provided by trained therapists in settings such as schools, primary care, or voluntary sectors ¹.

Antidepressants should not be used for initial treatment of mild depression in children and young people ¹.

Discuss the choice of psychological therapies with the young person and their family, explaining what each involves, the evidence base, and how they meet individual needs and preferences ².

Options include digital cognitive-behavioural therapy (CBT), group CBT, non-directive supportive therapy (NDST), or interpersonal psychotherapy (IPT). If these are unsuitable, consider attachment-based family therapy or individual CBT ².

Provide information on support groups and encourage lifestyle advice such as structured exercise, healthy diet, and good sleep hygiene. Support self-help strategies like CBT-based leaflets, online programs, or exercise sessions ¹.