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Treatments for depression in children usually consist of psychotherapy, medication or a combination of the two.

Psychotherapy is often valuable in helping children to address symptoms related to depression. This may include both individual therapy and family therapy sessions. Cognitive behavioral therapy (CBT) appears to be particularly effective in treating a child’s depression. As part of this therapy, children learn to develop a healthier, more positive view of themselves. Children may also benefit from interpersonal therapy (IPT), which focuses on a child’s relationship with others and attempts to improve the child’s interpersonal skills. Family therapy is a form of interpersonal therapy that involves the entire family. It may be particularly helpful when there are specific family-related stresses.

Medications such as antidepressants often provide significant relief from symptoms associated with depression. They are used most often in cases when psychotherapy alone fails to relieve symptoms and in situations where children have chronic or recurrent depression. These drugs help restore the proper balance of neurotransmitters in the brain and are typically used for a period of at least six months to one year. Some children may require long-term treatment that lasts for years. Although there has been little study regarding the efficacy of older drugs such as tricyclic antidepressants (TCAs) in treating depression in children and adolescents, newer selective serotonin reuptake inhibitors (SSRIs) do appear to be effective.

To date, only fluoxetine has been specifically approved by the U.S. Food and Drug Administration (FDA) to treat depression in children. However, many physicians prescribe other antidepressants on an “off-label” basis. This means physicians use their own judgment in deciding whether or not the drug may be helpful for the child, based on the child’s individual symptoms. This is considered to be a common and ethical practice, and in many cases these drugs are helpful for children with depression. However, recommendations vary between physicians, and parents are urged to discuss what is known about the drug with the physician, as well as weigh the potential benefits and risks of using such medications.

Parents should be aware that the FDA has advised that antidepressants – including fluoxetine – may increase the risk of suicidal thinking in some patients, especially children and adolescents, and all people being treated with them should be monitored closely for unusual changes in behavior. 

However, recent research indicates that the benefits of such medication in the treatment of depression far outweigh the risks.

Children and adolescents with bipolar disorder are usually treated with mood stabilizers (e.g., valproate) and antipsychotics. Supportive psychotherapy has been found beneficial as an additional treatment for bipolar disorder.

The FDA recommends special guidelines for children whose depression is being treated with medications. For the first month of treatment, children should visit the physician on a weekly basis. This should shift to every other week during weeks five through eight of treatment. If no problems emerge, the child should then visit the physician on week 12, and thereafter according to the physician’s recommendations.