What role do pharmacological treatments play in the management of depression in children and young people, and when should they be considered?

The role of pharmacological treatments in the management of depression in children and young people is primarily as an adjunct to psychological therapy, especially in cases of moderate to severe depression.

Antidepressant medication, specifically fluoxetine, is recommended for treating moderate to severe depression in children (5–11 years) and young people (12–18 years), as it is the only antidepressant with evidence showing that benefits outweigh risks ¹.

Antidepressants should only be prescribed following assessment and diagnosis by a child and adolescent psychiatrist, and usually in combination with psychological therapy ¹.

For children and young people with moderate to severe depression, combination treatment with psychological intervention plus fluoxetine may be considered for initial treatment, as an alternative to psychological intervention alone, with subsequent multidisciplinary review ².

Antidepressants such as sertraline or citalopram may be used if fluoxetine is not tolerated or ineffective, but only after a full assessment, informed consent, and a fair trial of psychological therapy ¹.

Antidepressants should not be used for mild depression initially; watchful waiting or psychological interventions are preferred first-line options ².

When prescribing antidepressants, close monitoring for adverse effects, including suicidal behaviour, is essential, especially at treatment initiation ¹.