Depression in adolescents

Around 3-5% of adolescents are affected by clinical depression worldwide.1 2 3 4 Although specific data on depression are not available, an Australian survey found 26% of adolescents with mental disorders were treated in general or paediatric practice, while only 9% received care from specialist mental health services.3

Episodes of depression generally last about seven to nine months. Probability of relapse is 40% within two years and 70% after five years.5 Depression can be devastating to a young person's academic and social development and can adversely affect family relationships, especially if the problems are misunderstood.

Optimal treatment for depression in adolescents is unclear. Concern about an increased rate of suicidal behaviours with antidepressants in trials in adolescents has led to safety warnings about their use in Europe, North America, and Australasia.6 Should adolescents with depression be prescribed antidepressants, and if so, should they be given only with psychotherapy?

In this week's BMJ, a randomised controlled trial (adolescent depression antidepressant and psychotherapy trial; ADAPT) by Goodyer …