Children and adolescents with moderate to severe major depression or persistent depression should be treated with cognitive-behavioral therapy (CBT), interpersonal therapy, and/or selective serotonin reuptake inhibitors (excluding paroxetine due to potential suicidal ideation), according to new practice guidelines released by the American Academy of Child & Adolescent Psychiatry (AACAP).
For youth with milder cases of depression, supportive interventions such as psychoeducation or counseling should be considered first, the guidelines panel noted.
These guidelines, which were published in the Journal of the American Academy of Child and Adolescent Psychiatry, are based on a comprehensive review of the evidence conducted by members of the AACAP Committee on Quality Issues. The members examined information from scientific articles, previously published practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, DSM-5-TR, and prescription drug information websites. A first draft of the guidelines was sent to relevant members of the AACAP community for edits and suggestions.
The 55-page guideline is broken down into the following sections:
- Overview of the guideline development process, including the scientific review and peer review process.
- Assessment of depression, including structured interview guides and safety evaluation.
- Treatment of depression, including strength of the evidence, risk/benefits of various psychotherapies and SSRIs, and areas for additional research.
- Limitations of the guideline.
“In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, research demonstrating convenient, efficient, cost-effective, and user-friendly delivery mechanisms (including telepsychiatry, web and telephone application-based adaptations of psychotherapy, trained mid-level practitioner- and lay-delivered treatments, collaborative care) for safe and effective treatment of child and adolescent depressive disorders is an urgent priority,” the guideline concluded.
For related information, see the Psychiatric News article “New Primary Care Guidelines Recommend Routine Screening for Depression in Adolescents.”
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