The UK’s “National Institute of Health and Clinical Excellence” – abreviated to NICE – issued guidelines on treating under-18s with depression. NICE is intended to give doctors best practice in treatment. In part this is driven by a cost saving for the National Health Service by not giving outdated or inappropriate treatments that have been shown not to be as effective.
Although the advice is intended for UK doctors and can include references to medical structures not present in the USA – it can be really useful background reading for parents whose children have illnesses. In this case there is also some useful advice for teachers and other similar professionals in identifying children with depression. The most important recommendation certainly has relevance to the US scene. It is that drugs alone should not be used. To quote the press release:
o Children and young people with moderate to severe depression should be offered, as a first-line treatment, a specific psychological therapy (such as cognitive behavioural therapy, interpersonal therapy or family therapy of at least 3 months’ duration).
o Antidepressant medication should not be offered to children or young people with moderate to severe depression except in combination with a concurrent psychological therapy and should not be offered at all to children with mild depression.
o Healthcare professionals in primary care, schools and other relevant community settings should be trained to detect symptoms of depression, and to assess children
and young people who may be at risk of depression.o Attention should be paid to the possible need for parents’ own psychiatric problems (particularly depression) to be treated in parallel, if the child or young person’s mental health is to improve.
Now I am not intending to offer you advice if you have already consulted a doctor. What you might want to do is look at the recommendations and the advice that is available in the various booklets. This page lists those and the formats they are available in. The formal guidelines have some interesting flow-charts about treatment decision but I will re-iterate the caution that some references are specific to the organisation of health treatments within the UK. Also remember these are also based on assessments of benefits against risks. There are considerable benefits and no health risks from talking therapies whereas the medications do carry risks of physical harming. Also note that even the recommended drugs are not licenced for use with children in the UK. If you investigate, you are likely to find the same applies in the USA.
The papers do point out a problem in the UK of a lack of trained therapists and I suspect a similar position for those specialised in treating the young will be similar in the USA. I also get the impression that anti-depressants are far more widely prescribed for children in the USA than here.
The guidelines do point out that medication alone is far less effective than in combination with a talking therapy. If anything, it will provide ammunition to argue with insurance companies etc about the best forms of treatment for your children. Simply pointing out the long term savings may well be enough to sway them to provide best practice.
