Management of mild childhood depression

Managing mild depression

Abbreviations: CBT, cognitive-behavioural therapy; IPT, interpersonal psychotherapy; IPT-A, IPT for adolescents; NDST, non-directive supportive therapy.

• Watchful waiting
  • for children and young people with diagnosed mild depression who do not want an intervention or who, in the opinion of the healthcare professional, may recover with no intervention, a further assessment should be arranged, normally within 2 weeks ('watchful waiting')
  • healthcare professionals should make contact with children and young people with depression who do not attend follow-up appointments
    
    
• Treatments for mild depression
  • for children and young people with learning disabilities, see the recommendations on psychological interventions in the NICE guideline on mental health problems in people with learning disabilities
    
    
  • antidepressant medication should not be used for the initial treatment of children and young people with mild depression
    
    
  • for 5- to 11-year-olds with mild depression continuing after 2 weeks of watchful waiting, and without significant comorbid problems or active suicidal ideas or plans, consider the following options adapted to developmental level as needed:
    • digital cognitive-behavioural therapy (CBT)
    • group CBT group
    • non-directive supportive therapy (NDST)
    • group interpersonal psychotherapy (IPT)
      
      
    • If these options would not meet the child's clinical needs or are unsuitable for their circumstances, consider the following adapted to developmental level as needed:
      • attachment-based family therapy
      • individual CBT
        
        
  • for 12- to 18-year-olds with mild depression continuing after 2 weeks of watchful waiting, and without significant comorbid problems or active suicidal ideas or plans, offer a choice of the following psychological therapies for a limited period (approximately 2 to 3 months):
    • digital CBT
    • group CBT
    • group NDST
    • group IPT
      
      
    • if the options in above would not meet the clinical needs of a 12- to 18-year-old with mild depression or are unsuitable for their circumstances, consider:
      • attachment-based family therapy or
      • individual CBT
        
        
  • if mild depression in a child or young person has not responded to psychological therapy after 2 to 3 months, refer the child or young person for review by a CAMHS team
    
    
  • follow the recommendations on treating moderate to severe depression for children and young people who have continuing depression after 2 to 3 months of psychological therapy

Notes:

• Tier 1
  • primary care services including GPs, paediatricians, health visitors, school nurses, social workers, teachers, juvenile justice workers, voluntary agencies and social services
    
    
• Tier 2 CAMHS
  • services provided by professionals relating to workers in primary care including clinical child psychologists, paediatricians with specialist training in mental health, educational psychologists, child and adolescent psychiatrists, child and adolescent psychotherapists, counsellors, community nurses/nurse specialists and family therapists
    
    
• Tier 3 CAMHS
  • specialised services for more severe, complex or persistent disorders including child and adolescent psychiatrists, clinical child psychologists, nurses (community or inpatient), child and adolescent psychotherapists, occupational therapists, speech and language therapists, art, music and drama therapists, and family therapists
    
    
• Tier 4 CAMHS
  • tertiary-level services such as day units, highly specialised outpatient teams and inpatient units

Reference:

• NICE (June 2019).Depression in children and young people: identifification and management