The NICE guideline for depression in children and young people was published way back in September 2005.  Any elf worth his salt will tell you that a whole heap of evidence has been published since then, so it’s good to see an evidence update appear this week from NICE, which brings together research published from 17th Aug 2010 to 14th Jan 2013.

A group of experts including psychiatrists, psychologists and primary care specialists has compiled this update.

Methods

They searched 9 biomedical databases looking for systematic reviews and RCTs and found 3,164 references, which they gradually whittled down to 8 records for inclusion in their report (3 systematic reviews and 5 RCTs).

Key points

Perhaps unsurprisingly given the long delay since the guidance was published, some of the new evidence found does have a potential impact on the existing NICE guideline:

• Mild depression
  • A group cognitive behaviour therapy (CBT) programme for preventing depression, delivered universally in a school setting, may not reduce symptoms of depression in young people at high risk of depression, and could increase reporting of symptoms
  • Computerised CBT may be a valid treatment option for young people with mild depression
• Moderate to severe depression
  • Combining CBT and newer antidepressants may bring some limited benefits in the short term over either therapy alone, particularly with regard to global functioning

Other key points were also made in the update, but these don’t have any impact on existing guidance:

• Care of all children and young people with depression
  • Limited evidence suggests that a range of factors (for example, gender, level of oppositionality, history of physical abuse) and family contextual issues (for example, parental marital discord) may moderate the effects of treatment
  • A modular approach to delivery of therapy may be a promising way to provide evidence-based treatments with the flexibility required for management of young people with multiple mental health problems
• Moderate to severe depression
  • When medication is used for children and young people, fluoxetine is the antidepressant of choice, because it is the only antidepressant licensed for this use. There remains little evidence to inform views on the relative value of other antidepressants

Uncertainties

This work also flagged up two new treatment uncertainties that have been added to the UK DUETs database:

1. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents
2. Newer generation antidepressants for depressive disorders in children and adolescents

Links

Depression in children and young people (PDF). NICE Evidence Update 42, June 2013.

Amaya MM, Reinecke MA, Silva SG et al. (2011) Parental marital discord and treatment response in depressed adolescents. Journal of Abnormal Child Psychology 39: 401–11. [PubMed abstract]

Calati R, Pedrini L, Alighieri S et al. (2011) Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis. Acta Neuropsychiatrica 23: 263–71. [DARE summary]

Cox GR, Callahan P, Churchill R et al. (2012) Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database of Systematic Reviews issue 11: CD008324

Hetrick SE, McKenzie JE, Cox GR et al. (2012) Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews issue 11: CD004851

Merry SN, Stasiak K, Shepherd M et al. (2012) The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: a randomised controlled non-inferiority trial. British Medical Journal 344: e2598.

Shamseddeen W, Asarnow JR, Clarke G et al. (2011) Impact of physical and sexual abuse on treatment response in the Treatment of Resistant Depression in Adolescent Study (TORDIA). Journal of the American Academy of Child and Adolescent Psychiatry 50: 293–301.

Stallard P, Sayal K, Phillips R et al. (2012) Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: pragmatic cluster randomised controlled trial. British Medical Journal 345: e6058. [PubMed abstract]

Weisz JR, Chorpita BF, Palinkas LA et al. (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth. Archives of General Psychiatry 69: 274–82.