Is it necessary to use antidepressant medication in treatment of depressive disorders in children and adolescents?

Depressive disorders are common in children and adolescents, with suggested overall prevalence rates for children (under 13 years) 2.8% and for adolescents (13 to 18 years) 5.7%. If left untreated, depressive disorders in the younger years are likely to continue into adulthood, and can be increasingly difficult to treat as time goes on. Psychological therapies and antidepressant medication can be used to treat depression in children and adolescents. Psychological therapies in common use are cognitive behavioural therapy, interpersonal psychotherapy and psychodynamic therapy. A systematic review indicated that overall, psychotherapy is more effective than control comparisons immediately post-intervention, although this benefit is no longer evident at six months and 12 months follow-up. Subgroup analysis suggested that psychotherapy might be more effective than control for adolescents (13 to 19 years) but not for younger children (six to 12 years). There are many different types of antidepressant medication, all of which have been developed specifically to work on chemicals in the brain that are believed to be linked to depression. The majority of guidelines on the treatment of depressive disorders in young people recommend selective serotonin reuptake inhibitors (SSRIs). The SSRI for which there is the most consistent evidence of a statistically significant reduction in depressive symptoms compared with placebo is şuoxetine. National Institute for Health and Clinical Excellence (NICE) guidelines state specifically that şuoxetine should be the first antidepressant medication option. In TADS, şuoxetine alone was superior to CBT alone, and the combination of şuoxetine and CBT was statistically significantly better than either alone in the short-term. However, the difference between SSRI and combination therapy is stated to be insignificant in long term follow-up studies. As a conclusion, evidence about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions is limited. Further studies are needed to establish a guideline on this topic.