The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health have today (28 September) launched a clinical guideline on the treatment and management of depression in children and young people. The guideline recommends that -

• Children and young people with moderate to severe depression should be offered, as a first-line treatment, a specific psychological therapy (such as cognitive behavioural therapy, interpersonal therapy or family therapy of at least 3 months’ duration).

• Antidepressant medication should not be offered to children or young people with moderate to severe depression except in combination with a concurrent psychological therapy and should not be offered at all to children with mild depression.

• Healthcare professionals in primary care, schools and other relevant community settings should be trained to detect symptoms of depression, and to assess children and young people who may be at risk of depression.

• Attention should be paid to the possible need for parents’ own psychiatric problems (particularly depression) to be treated in parallel, if the child or young person’s mental health is to improve.

Andrew Dillon, Chief Executive of NICE and Executive Lead for this guideline says “This guideline makes it clear that psychological treatments are the most effective way to treat depression in children and young people. It’s important that children and young people taking anti-depressants do not stop taking them abruptly, but we would advise people to talk to their GP at their next regular review about whether a psychological treatment may be a more effective treatment option.”

Dr Tim Kendall, Joint Director of the National Collaborating Centre for Mental Health who developed the guideline on behalf of NICE says “This is the sixth mental health guideline where we have recommended psychological treatments as key treatments for a mental health condition and the third where we have recommended them as the first line treatment. The evidence supporting these treatments is robust and it is vital that the NHS provides psychological therapies to ensure everyone who needs these treatments can access them rapidly.”

Professor Peter Fonagy, Professor of Psychoanalysis and Chair, Guideline Development Group says “Depression in children is more common than many people realise and often goes unrecognised. Around 1% of children and 3% of adolescents will suffer from depression in any one year. It can severely impact on school performance, self esteem and making and retaining friendships. It can lead to a greatly increased risk of mental health problems in adult life and at its most serious it can dramatically increase the lifetime risk of suicide, from 1.3% in the general population to 6%.”

Ms Charlotte Dodds, Depression Support Group Co-Facilitator and Carer Representative on the Guideline Development Group says “Depression disproportionately affects the most disadvantaged children. Children and young people with emotional disorders, when compared with children without a mental disorder, were nearly twice as likely to be living with a lone parent (28% versus 15%), more than twice as likely to be with both parents being unemployed (27% versus 12%), and more likely to have parents who were on low incomes, had fewer qualifications and living in social sector housing. I hope this guideline raises awareness of the issue and encourages more equal access to treatments for all children and young people with depression, no matter where or how they live.”

Ms Dinah Morley, Deputy Director of YoungMinds says “YoungMinds welcomes the emphasis on psychological therapies as the best approach to the treatment of depression. However the very significant shortage of practitioners able to deliver these therapies is a cause for concern, as is the general lack of awareness of the prevalence of depression in babies, children and young people. We look to increasing investment in services which support the mental health of children and young people and to improvements in the training of all practitioners working with children, to help them in identifying symptoms of depression and in seeking effective help. Too many children’s lives are blighted by depression, a condition for which there are effective treatments. We welcome the NICE guidelines as another reminder that children’s mental health matters and is the business of everybody.”

The Committee on the Safety of Medicines issued advice on the safety of antidepressant medication for children in 2003. The NICE guidance complements and builds on this advice.

About NICE

1 On 1 April 2005 the National Institute for Clinical Excellence took on the functions of the Health Development Agency to form the National Institute for Health and Clinical Excellence (NICE). NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2 NICE produces guidance in three areas of health:
_ public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
_ health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
_ clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

About Yound Minds

1 YoungMinds is the national charity committed to improving the mental health of all children and young people.
The YoungMinds Parents’ Information Service (0800 018 2138) provides information and
advice for anyone with concerns about the mental health of a child or young person.

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