NICE clinical guidelines
Issued: September 2005 (last modified: March 2015)
CG28

Depression in children and young people: Identification and management in primary, community and secondary care

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg28

Introduction

Recommendations on psychological therapies and antidepressants have been added to and updated in sections 1.5 and 1.6. The addendum contains details of the methods and evidence used to update these recommendations.

This guideline covers the identification and treatment of depression in children (5–11 years) and young people (12–18 years) in primary, community and secondary care. Depression is a broad diagnosis that can include different symptoms in different people. However, depressed mood or loss of pleasure in most activities, are key signs of depression. Depressive symptoms are frequently accompanied by symptoms of anxiety, but may also occur on their own. The International Statistical Classification of Diseases (ICD‑10) uses an agreed list of 10 depressive symptoms, and divides depression into 4 categories: not depressed (fewer than 4 symptoms), mild depression (4 symptoms), moderate depression (5 to 6 symptoms), and severe depression (7 or more symptoms, with or without psychotic symptoms). For a diagnosis of depression, symptoms should be present for at least 2 weeks and every symptom should be present for most of the day.

For the purposes of this guideline, the management of depression has been divided into the following categories as defined by the ICD‑10:

  • mild depression

  • moderate and severe depression

  • severe depression with psychotic symptoms.

However, it is not clear whether the severity of depression can be understood in a single symptom count. Family context, previous history, and the degree of associated impairment are all important in helping to assess depression. Because of this, it is important to assess how the child or young person functions in different settings (for example, at school, with peers and with family), as well as asking about specific symptoms of depression.

Safeguarding children

Remember that child maltreatment:

  • is common

  • can present anywhere, such as emergency departments and primary care or on home visits.

Be aware of or suspect abuse as a contributory factor to or cause of the symptoms or signs of depression in children. Abuse may also coexist with depression. See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.

This section has been agreed with the Royal College of Paediatrics and Child Health.

Recommendations about medicines

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some medicines for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information. Where recommendations have been made for the use of medicines outside their licensed indications ('off‑label use'), these medicines are marked with a footnote in the recommendations.