Depression in children

After treatment is initiated, weekly to bi-weekly follow-up visits are needed to monitor adverse effects and symptom change and response. Ongoing assessment of functioning in several key domains is required (home, school, and peer settings), as well as assessments of suicidality.[85]Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018 Mar;141(3):e20174082. https://publications.aap.org/pediatrics/article/141/3/e20174082/37654/Guidelines-for-Adolescent-Depression-in-Primary http://www.ncbi.nlm.nih.gov/pubmed/29483201?tool=bestpractice.com If a child makes good progress and the treatment is an appropriate choice for the child, the visit frequency may be reduced to once every 4 to 6 weeks during the continuation phase of treatment. Despite guidelines recommending regular follow-up care, the majority of youth being treated with antidepressants do not receive adequate follow-up care.[176]Morrato EH, Libby AM, Orton HD, et al. Frequency of provider contact after FDA advisory on risk of pediatric suicidality with SSRIs. Am J Psychiatry. 2008 Jan;165(1):42-50. http://www.ncbi.nlm.nih.gov/pubmed/17986680?tool=bestpractice.com Monitoring during the continuation phase of treatment is also important, as the relapse rate is high. Compliance becomes a bigger issue during the continuation phase of treatment. Having a good relationship with patients and their families may improve adherence.

Part of the monitoring should also include asking about engagement in therapy. Most children being monitored for depression should have access to a therapist or counsellor. It is important to determine whether the child is regularly attending, and whether they find any benefit. If not, encourage them or their carers to speak to the therapist. This is particularly important if the child is not progressing or is getting worse.