The UK National Institute of Health and Clinical Excellence has ruled that antidepressants should only be given to children and adolescents with moderate to severe symptoms.

Mild cases of depression in these patient groups should not be treated with drugs at all, and even in those who are eligible for drug therapy, a three-month course of psychological counselling should be the first-line treatment, said the agency.

If no improvement is seen after this period, pharmacological therapy - initially with the generically available selective serotonin reuptake inhibitor fluoxetine - can be given alongside psychological counselling, according to the guidance.

If this is ineffective, alternative drug treatment with Pfizer’s Zoloft (sertraline) or Lundbeck’s Cipramil (citalopram) can be considered, although as these are not approved for use in patients aged under 18, this will require off-label prescribing. GlaxoSmithKline’s Paxil (paroxetine) and Wyeth’s Effexor (venlafaxine) should not be used in patients aged under 18 under any circumstances, according to the guidance, in line with earlier recommendations to restrict their use to adult patients because of safety issues [[10/12/04a]] [[07/12/04a]].

Andrew Dillon, chief executive of NICE, said: “This guideline makes it clear that psychological treatments are the most effective way to treat depression in children and young people.” At least 40,000 children and young people in the UK, aged from five to 16, are estimated to be taking antidepressants, of whom less than 20,000 are receiving psychological therapy. The NICE also called for further training of healthcare professionals to help them detect the symptoms of depression in young people.