Treatment and Assessment of Disease
Diagnosis
����The treatment of depressive disorders should always include an acute
and continuation phase; some children may also require maintenance
treatment (MS).
����Each phase of treatment should include psychoeducation, supportive
management, family and school involvement (MS).
����Education, support, and case management appear to be sufficient
treatment for the management of depressed children and adolescents
with an uncomplicated or brief depression or with mild psychosocial
impairment (CG). For children and adolescents who do not respond to
supportive psychotherapy or who have more complicated depressions,
a trial with specific types of psychotherapy and/or antidepressants is
indicated (CG).
����Combined therapy (psychotherapy + SSRIs) seems to work faster than
monotherapy and is better for treatment resistant cases.
����During all treatment phases, clinicians should arrange frequent follow-up
contacts that allow sufficient time to monitor the subject���s clinical status,
environmental conditions, and, if appropriate, medication side effects
(MS).
����During all treatment phases, for a child or adolescent who is not
responding to appropriate pharmacological and/or psychotherapeutic
treatments, consider factors associated with poor response (MS).
����To consolidate the response to the acute treatment and avoid relapses,
treatment should always be continued for 6 to 12 months (MS).
����To avoid recurrences, some depressed children and adolescents should
be maintained in treatment for longer periods of time (CG).
����If antidepressants are prescribed, close and careful evaluation for
a possible increase in suicidal ideation and development of manic/
hypomanic symptoms is necessary.
Special Circumstances
����Depressed patients with psychosis, seasonal depression, and bipolar
disorder may require specific somatic treatments (CG).
����Treatment should include the management of comorbid conditions (MS).
To improve the child���s response, parents should be referred for separate
but concurrent counseling to address their own issues.
2
