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	Florida Best Practice Guidelines for Depression in Children Under Age Six In the area of depression, the panel recommended the following for children under the age of six: Level 0: An appropriate diagnostic assessment, including a caregiver and family assessment, should be the first step. Second, the development of a psychosocial intervention and treatment strategy of the family and/or caregiver, if necessary, should be considered. This was recommended due to recent published articles that examined the correlation between depressed parents and children and the findings that the mental health of children improved when parents were treated for depression. Level I: The panel agreed to support the use of emerging best practices in the use of psychosocial therapies from behavior therapy to family behavior therapy and other current practices in psychosocial therapy. The panel was informed that a separate group would be assembled to develop the specifics of the different therapies available for children and adolescents that are non-biological. The expert panel decided not to support any pharmacological recommendations in the treatment for depression for children under six years of age due to the fact that there is not a large body of science to support this and the potential safety issues involved in the use of antidepressants in children. Florida Best Practice Guidelines for Depression in Children From Age Six to Adolescence With regards to children from ages six to adolescence: Level 0: Diagnostic assessment, caregiver and family assessment, and, if possible, collateral information from the school setting and psychosocial intervention and treatment strategy of family and/or caregiver if necessary. Level I: The expert panel decided to make psychotherapy (i.e., cognitive behavioral therapy and family therapy) appropriate options for treatment in the Level I category. Other emerging best practices in psychotherapy can also be utilized and these will be fully delineated by a later expert panel. Level II: SSRI monotherapy for two iterations were recommended. Level III: Reassessment of the diagnosis in the environment to ensure that non-biological issues are addressed and to determine whether the diagnosis of depression is appropriate. Level IV: If there has been a failure of two separate trials of SSRI monotherapy, alternative antidepressants can be utilized if there is no contributing comorbidity or occurring disorder. Level V: Augmentation with lithium or buspirone can be done sequentially. Agents other than those mentioned above can be used but multiple antidepressants should be avoided. The expert panel did discuss options for psychosis, tics, and other conditions in upcoming recommendations. Florida Best Practice Guidelines for Depression in Adolescence Level 0: A diagnostic assessment, caregiver and family assessment, and, if possible, collateral information from the school setting and psychosocial intervention and treatment strategy of family and/or caregiver if necessary. Level I: Only one pharmacotherapy agent, fluoxetine, is recommended as it is the only agent with proven efficacy in a well-controlled, randomized control trial. Level II: Medications including sertraline and citalopram have some evidence to support their use. The results from small, randomized control trials do not support the use of mirtazapine, paroxetine, or venlafaxine in this population. Other SSRI have some limited evidence from small open studies and randomized control trials. Bupropion may also be considered at this level. Level III: Re-evaluation and consideration of empirically supported psychotherapy, if not already part of the clinical treatment approach, either in combination or alone as part of the treatment. Although this panel was meant to develop guidelines for the use of medications at this level, the panel thought that it was important to support the use of cognitive behavioral therapy if it had not already been implemented in this age group, as emerging evidence indicates that psychotherapy can be very beneficial in this population. Level IV: Augmentation with two agents with targeting symptoms, for instance the use of alternative agents, stimulants for comorbid ADHD, atomoxetine or antipsychotics for psychotic features, buspirone, and/or lithium are all considered options but there is no necessity for using two antidepressants at the same time, unless one was attempting a crossover strategy. Level V: The use of three agents but primary using symptom targeting as the basis for co-occurring psychotic symptoms, anxiety symptoms, and/or ADHD symptoms. Level VI: The expert panel recommends that the AACAP parameters for ECT should be followed. Child & Adolescent    » ADHD    » Depression    » Bipolar Disorder    » Tourettes Syndrome    » Aggression Adults    » Schizophrenia    » Bipolar Disorder