Psychological therapy must accompany antidepressants in young people
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* Susan Mayor

Antidepressants should be considered for treating children or young people with moderate to severe depression only in combination with concurrent psychological therapy and with careful monitoring for side effects, and they should not be used at all in children with mild depression. These are among the recommendations of a clinical guideline published this week for the NHS in England and Wales.

  
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**St John's wort (above) should not be used in children**

Credit: ARS/USDA

“The guideline makes it clear that medication is not the first line treatment for children and young people with depression. Antidepressants should only be considered when psychological treatments are not working, and should only be used in combination with a psychological treatment,” explained David Cottrell, professor of child and adolescent psychiatry at the University of Leeds.

Professor Cottrell was a member of the group that developed the guideline for the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health.

Once depression has been diagnosed and assessed, the guideline recommends that children and young people with moderate to severe depression should be offered a specific psychological therapy, such as cognitive behaviour therapy, interpersonal therapy, or family therapy.

Fluoxetine was recommended as the only antidepressant for which trials show that its benefits outweigh the risks, with sertra-line or citalopram recommended as second line treatments. The guideline cautioned that paroxetine and venlafaxine, tri-cyclic antidepressants, and St John's wort should not be used in children or young people.

## Footnotes

*   ![Graphic][2]</img> Longer versions of these articles are on [bmj.com](http://bmj.com/)
    
    *Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care* is accessible at [http://www.nice.org.uk/](http://www.nice.org.uk/).

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