Editor's note

The treatment of depression in children and adolescents has commanded much attention in the news in both the USA and the UK. In the UK, there are very strong guidelines against the use of any SSRI antidepressants except fluoxetine, and the guidelines urge that, if fluoxetine is used, it should be used only in moderate to severe cases and should always be accompanied by some psychotherapeutic efforts. In the USA, the advice is somewhat less strict in that SSRIs other than fluoxetine are not advised against, but there is a ‘block box’ issued that reminds clinicians to weigh the costs vs. the benefits of SSRI usage. One of the costs of using SSRIs may be an increase in suicidal ideation if not actual suicide among users of these medications, though the evidence here is not as strong as critics of SSRI usage would like it to be. Psychotherapeutic treatments, especially cognitive-behavioural treatment (CBT) and interpersonal therapy (IPT) have been shown to be effective interventions for depression in youth. Yet there are also questions not to its effectiveness per se, but as to the duration of the effectiveness. The current thinking in the treatment of depression in both children and adolescents suggests that in milder depression one should try non-pharmacologic treatments at first, and if they do not prove to be effective, then pharmacologic treatment can be added.