Medication for depression

NICE guidance recommends psychological interventions as treatment for mild depression in children and young people. In moderate to severe depression, pharmaceutical treatment in combination with psychological interventions can be considered.

Any pharmaceutical treatment should be initiated and overseen by a psychiatrist within child and adolescent mental health services (CAMHS). When medication is deemed appropriate, fluoxetine is NICE’s recommended first-line treatment.

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). As with all antidepressants, it can take up to two to four weeks to have a positive impact. Patients need to be aware of this so they have realistic expectations.

SSRIs are often associated with gastrointestinal side-effects such as nausea and diarrhoea during the initial weeks of treatment. Often, these side-effects are mild and transient, but if they are not, further advice would need to be sought from the prescriber. SSRIs can also be associated with insomnia so, ideally, they should be taken in the morning to minimise the risk of sleep disturbances. Another common side-effect is sexual dysfunction (e.g. loss of libido, erectile dysfunction). These side-effects may be particularly impactful to an adolescent.

If treatment with fluoxetine is ineffective or poorly tolerated, the young person’s psychiatrist may consider a switch to a different SSRI, such as sertraline or citalopram. Herbal medications (e.g. St John’s Wort) are not recommended by NICE in the treatment of depression in young people.