Psych · Child and adolescent psychiatry — depression
Child and adolescent depression
Also known as Adolescent depression · Paediatric major depression · Youth MDD · Childhood depression · CAMHS depression · Teen depression fluoxetine · TADS depression · Juvenile unipolar depression
Exam-exhaustive fellowship reference on child and adolescent depression — DSM-5-TR/ICD-11 developmental criteria (irritable mood), epidemiology, multi-informant assessment with private youth interview plus family and school, suicide and self-harm risk, organic and bipolar differentials, stepped care, fluoxetine dosing and activation monitoring, CBT/IPT-A/family work, TADS ADAPT TORDIA IMPACT evidence, GLAD-PC/NICE/RANZCP/AACAP framing, Gillick competence and disposition. Distinct from adult major-depressive-disorder and youth-self-harm-and-suicide topics. FRANZCP-primary, globally tagged.
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FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- Active suicidal intent, plan, preparatory behaviour, or recent attempt — same-day senior review, means restriction with carers, documented safety plan; do not discharge to an empty plan
- New or worsening suicidal ideation, agitation, or akathisia after starting or increasing an antidepressant — reassess risk and care intensity immediately
- Mixed features, prior hypomania/mania, or strong bipolar family history — do not treat as uncomplicated unipolar depression with antidepressant monotherapy alone
- Psychotic depression, catatonic features, or life-threatening poor intake — urgent escalation; consider ECT pathway discussion in rare severe cases
- Safeguarding concerns (abuse, neglect, exploitation) — escalate child-protection pathways; do not reframe as 'family conflict only'
- Promising absolute confidentiality when safety requires carer involvement, or relying on a no-suicide contract instead of a real safety plan
Meet the patient
A 15-year-old is brought in by her father because her grades collapsed and "she's become impossible". She has not seen a friend in six weeks, sleeps until 2pm at weekends, and snaps at everyone. Her father wants to know why she is so angry. She has not said a word in the waiting room.[6][18]
Send the father out. Everything that matters — the ideation, the vaping, the group chat that turned on her, the paracetamol she counted last Tuesday — arrives in the ten minutes after the door closes. The single highest-yield act in youth depression is seeing the young person alone.[6][10][14]
References24ShowHide
- [1]March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial JAMA, 2004.PMID 15315995
- [2]March JS, Silva S, Petrycki S, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes Arch Gen Psychiatry, 2007.PMID 17909125
- [3]Goodyer I, Dubicka B, Wilkinson P, et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial BMJ, 2007.PMID 17556431
- [4]Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial JAMA, 2008.PMID 18314433
- [5]Hammad TA, Laughren T, Racoosin J Suicidality in pediatric patients treated with antidepressant drugs Arch Gen Psychiatry, 2006.PMID 16520440
- [6]Birmaher B, Brent D, Bernet W, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders J Am Acad Child Adolesc Psychiatry, 2007.PMID 18049300
- [7]Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial J Am Acad Child Adolesc Psychiatry, 2002.PMID 12364842
- [8]Emslie GJ, Heiligenstein JH, Hoog SL, et al. Fluoxetine treatment for prevention of relapse of depression in children and adolescents: a double-blind, placebo-controlled study J Am Acad Child Adolesc Psychiatry, 2004.PMID 15502599
- [9]Kennard B, Silva S, Vitiello B, et al. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS) J Am Acad Child Adolesc Psychiatry, 2006.PMID 17135985
- [10]Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management Pediatrics, 2018.PMID 29483200
- [11]Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management Pediatrics, 2018.PMID 29483201
- [12]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
- [13]Kroenke K, Spitzer RL, Williams JB The PHQ-9: validity of a brief depression severity measure J Gen Intern Med, 2001.PMID 11556941
- [14]Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults Am J Psychiatry, 2011.PMID 22193671
- [15]Wilkinson P, Kelvin R, Roberts C, et al. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT) Am J Psychiatry, 2011.PMID 21285141
- [16]Goodyer IM, Reynolds S, Barrett B, et al. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial Lancet Psychiatry, 2017.PMID 27914903
- [17]Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis Lancet, 2016.PMID 27289172
- [18]Thapar A, Collishaw S, Pine DS, Thapar AK Depression in adolescence Lancet, 2012.PMID 22305766
- [19]Avenevoli S, Swendsen J, He JP, et al. Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment J Am Acad Child Adolesc Psychiatry, 2015.PMID 25524788
- [20]Cox GR, Callahan P, Churchill R, et al. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents Cochrane Database Syst Rev, 2014.PMID 25433518
- [21]Cha CB, Franz PJ, M Guzmán E, et al. Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment J Child Psychol Psychiatry, 2018.PMID 29090457
- [22]Loades ME, Midgley N, Herring GT, et al. In Context: Lessons About Adolescent Unipolar Depression From the Improving Mood With Psychoanalytic and Cognitive Therapies Trial J Am Acad Child Adolesc Psychiatry, 2024.PMID 37121393
- [23]Byford S, Barrett B, Roberts C, et al. Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression Br J Psychiatry, 2007.PMID 18055956
- [24]Domino ME, Foster EM, Vitiello B, et al. Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial J Am Acad Child Adolesc Psychiatry, 2009.PMID 19465880