Medication for moderate to severe depression and psychotic depression

Some evidence – there is enough evidence to indicate that this can be a helpful treatment option for young children with moderate to severe depression and psychotic depression.

Medication will only usually be suggested if you are 12- 18 years old, have moderate to severe depression and: 

  • are not getting better with a psychological treatment 
  • have very severe depression and might find it hard to try a psychological therapy  
  • do not want to try a psychological therapy 

If you decide to take medication for depression then either the doctor who prescribes your medication or another professional in your CAMHS team should meet with you regularly.   

The first type of medication you are likely to be offered is fluoxetine which is a type of antidepressant medication called a selective serotonin reuptake inhibitor, or SSRI. If you are under 12 and therapy is not helping, then you and your family could talk with your professional about whether to try fluoxetine, but it is important to know that fluoxetine has not yet been shown to be effective for children under 12. 

While you are taking medication your professional should keep a close eye on side effects and check in regularly with you about how you are feeling, particularly in the first 4-6 weeks or if you change the dose (as these can cause a temporary increase in side-effects including feeling agitated or thoughts of self-harm) 

Time course for improvement  

All types of medication for depression take a few weeks to work. The benefits should then increase over several weeks. It is important that you and your family are aware of this, as you may not notice a change at first. 

If there is no improvement at all after four weeks then your treatment should be reviewed and your professional should talk with you about increasing or changing your medication 

Second option medications

Sometimes the first type of antidepressant you try does not work. If this is the case, then your doctor should talk with you about whether there is anything happening in your life that is stopping you getting better (such as other mental or physical health conditions or things happening at home or school). Your doctor might recommend a different type of therapy such as a talking therapy alongside your medication 

They might also recommend increasing the amount of fluoxetine you take each day, although this might cause an increase in side-effects. Your doctor might also recommend trying a different type of antidepressant medication. This could be a different SSRI (e.g. sertraline or citalopram) and although these are all very similar to fluoxetine it can be worth trying one of them to see whether it is better at making a difference to your symptoms.

Third option medications

Although most children and young people recover with the combination of fluoxetine (or an alternative SSRI) and psychological therapies, occasionally this doesnt help.  

In some circumstances your doctor might recommend an alternative antidepressant medication such as mirtazapine. However, while there is good evidence that it is effective and safe for adults, we don’t know whether this applies to young people.   

Low doses of atypical antipsychotics in combination with fluoxetine or another SSRI are also sometimes recommended if someone’s depression hasnt responded to other treatment (e.g. olanzapine, aripiprazole and quetiapine). The evidence for this again comes from studies in adults and clinical experience but there is little research involving young people.  

Medications which you should not be prescribed

Some antidepressants should not be prescribed for under 18s: 

  • paroxetine 
  • venlafaxine 
  • tricyclic antidepressants  

There is evidence for these types of medication that the risks outweigh any benefits and there is poor evidence of effectiveness in most young people.  

St John’s wort is a herbal medicine used by some adults for depression. It is not recommended in young people because there is no evidence of its effectiveness. 

How long should I keep taking antidepressants?

Stopping medication may mean that your symptoms come back. The longer someone is well before medication is stopped, the more likely it is that they will stay well when they stop taking the medication. 

Often young people will stay on antidepressants for some time after recovery: 

  • For 6 months after a first episode of depression 
  • For 2 years after a second episode of depression  
Stopping antidepressants

Sometimes people get discontinuation symptoms’ when they stop taking antidepressant medication. This does not mean that they are addictive, but it is unpleasant and happens because of adjustments in how the body functions when the medication is no longer in your system. These symptoms might also happen if you miss a dose. 

Because of this, doses of antidepressant medication should be reduced gradually over several weeks (sometimes months). 

Medication for psychotic depression

Psychotic depression happens when severe depression becomes associated with hallucinations such as hearing voices and/or delusions or unusual beliefs. If you have psychotic depression, your current treatment plan should include an atypical antipsychotic medication. Although there is good evidence from treatment of adults with psychotic depression there isnt yet good research evidence in children and young people on the most effective dose or how long you need to take the antipsychotic medication.

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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