Principles of treating major depression in children

Principles of treating major depression in children are similar to those for adults and young people (see Principles of treating major depression in adults and young people); however:

• nonpharmacological management involves identifying and addressing factors that may contribute to their disorder, which can include family conflict or parental mental health issues, physical or sexual abuse (mandatory reporting guidelines must be followed), school difficulties or problems with peers
• psychological therapies are preferred
• pharmacotherapy may be used in children older than 6 years if psychological therapies are not available, not effective or not preferred, or if symptoms are severe. There is limited evidence to support the efficacy of antidepressants, and the long-term safety of treatment is unknown. Carefully consider the need for antidepressant therapy and, if possible, seek specialist advice before starting treatment. Only consider using pharmacotherapy for major depression in children within the context of a comprehensive management plan
• there are inconsistent results from trials investigating the additional benefit of combining nonpharmacological treatments (eg cognitive behavioural therapy) with antidepressant treatment in children with depression. Despite this, if antidepressant treatment is necessary, it should be combined with psychological therapy
• electroconvulsive therapy (ECT) is rarely used in children; it is a highly specialised therapy and is subject to specific state and Territory legislation
• other physical treatments such as direct current stimulation (DCS), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS) and bright light therapy have not been evaluated for efficacy and safety in children with depression and are not recommended
• the efficacy and safety of complementary medicines such as St John’s Wort and omega-3 fatty acid supplementation is not established.