Surveillance decision

Surveillance decision

We will plan an update of the guideline on depression in children and young people. The update will focus on psychological therapy for treatment of depression in children.

During surveillance editorial or factual corrections were identified. Details are included in appendix A: summary of evidence from surveillance.

Reason for the decision

Assessing the evidence

We found 107 studies through surveillance of this guideline.

Evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated.

Treatment for moderate to severe depression
  • What is the most effective psychological intervention for children and young people with depression?

A trial funded by the National Institute for Health Research (the IMPACT study) has provided new evidence on psychological interventions for children and young people with depression. The IMPACT trial results are directly relevant NICE's guideline on depression in children and young people and form the basis of this update decision.

The aim of the IMPACT study was to determine whether either of two specialist psychological treatments, cognitive behavioural therapy or short-term psychoanalytic psychotherapy, were more effective than a reference brief psychosocial intervention in maintaining reduction of depression symptoms in the year after treatment. This trial was raised by stakeholders during consultation for the guideline, subsequently added to the NICE surveillance programme trial tracker and results considered in detail when they became available.

The results of the IMPACT study have been described in detail in an NIHR signal. In summary, the new evidence suggests that a brief psychosocial intervention was as clinically effective as short-term psychoanalytical therapy and CBT interventions. Furthermore, a cost-effectiveness analysis showed no difference in cost between the interventions. NICE guideline CG28 currently recommends CBT, interpersonal therapy, family therapy, or psychodynamic psychotherapy as a first line treatment for children and adolescents with moderate to severe depression. Topic experts agreed that guidance may need updating in light of the new evidence on the effectiveness of a brief psychosocial intervention.

Decision: This review question should be updated.

We also found evidence that supports current recommendations in the area of self-help interventions, family support, the organisation and planning of services, and exercise interventions.

We found evidence on the following areas not covered in the guideline:

  • New risk factors including inflammatory markers, levels of screen-time, genetic factors.

  • Interventions to reduce depressive symptoms in children who are at high risk of developing depression.

  • A pharmacological treatment 'Selegiline transdermal system' for depression which is not available in the UK.

  • Complementary and alternative medicine.

  • Transcranial magnetic stimulation therapy.

This evidence was considered to be insufficient in volume and consistent results to add new recommendations in these areas at this time.

We found evidence on the choice of screening tools in the detection and diagnosis of depression in children and young people. These findings were considered too inconsistent to have an impact on guidance at this point. However, we will make an editorial correction to recommendation 1.4.1.1 which currently states that MFQ is the best tool to use in the initial screening stage of depression. This statement will be removed from the recommendation. See appendix A: summary of evidence from surveillance for further details of this editorial correction and the rationale for this.

We found evidence on the use of antidepressants for the treatment of depression in children and young people. The findings were generally supportive of recommendations. However there was some evidence to suggest that duloxetine, which is not currently covered in the guideline, is associated with more discontinuations due to adverse events. Currently, the guideline does not make any recommendations on the use of duloxetine but does advise against the use of paroxetine, venlafaxine and tricyclic antidepressants due to adverse events (see recommendation 1.6.4.13). The majority of topic experts were in agreement that the evidence on duloxetine is considered too preliminary at this point to impact guidance.

We found evidence on the use of combination therapy with antidepressants and psychological therapy. The evidence suggested that it is not possible to say whether combination therapy is more effective than antidepressants alone. The antidepressant currently recommended in the guideline is fluoxetine which is the only antidepressant licensed for this indication in children. The licensing indication states that fluoxetine should be given alongside psychological therapy in children, therefore the recommendations are unlikely to be affected at this point.

We found evidence on the transition to adult services however it was considered not to impact the current recommendations. Topic experts raised concerns over poor outcomes in transitional care, highlighting observational evidence to support this. Although the evidence was found not to affect the current guidance, we will consider the implementation of the NICE guideline on transition from children's to adults' services for young people using health or social care services (NG43, published February 2016) recommendations at the next surveillance and review how this may impact the current guidance.

We did not find any evidence relating to:

  • Information, informed consent and support.

  • Language and ethnic minorities.

  • Watchful waiting.

  • Inpatient care.

  • Electroconvulsive therapy.

  • Recurrent depression and relapse prevention.

  • Discharge after a first episode.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts, we decided that a partial update is necessary for this guideline.

See how we made the decision for further information.


This page was last updated: 24 August 2017