Treatment
Diagnosis and Assessment of Disease
ÎThe treatment of depressive disorders should always include an acute and continuation phase; some children may also require maintenance treatment (MS).
ÎEach phase of treatment should include psychoeducation, supportive management, family and school involvement (MS).
ÎEducation, 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).
ÎCombined therapy (psychotherapy + SSRIs) seems to work faster than monotherapy and is better for treatment resistant cases.
ÎDuring 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).
ÎDuring 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).
ÎTo consolidate the response to the acute treatment and avoid relapses, treatment should always be continued for 6 to 12 months (MS).
ÎTo avoid recurrences, some depressed children and adolescents should be maintained in treatment for longer periods of time (CG).
ÎIf antidepressants are prescribed, close and careful evaluation for a possible increase in suicidal ideation and development of manic/ hypomanic symptoms is necessary.
Special Circumstances
ÎDepressed patients with psychosis, seasonal depression, and bipolar disorder may require specific somatic treatments (CG).
ÎTreatment 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.
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