Question: Is there strong evidence to prove that medication is more effective than therapeutic interventions in improving psychological wellbeing in children and young adults in mental health services?

Answer:

Evidence from one high quality systematic review and mixed treatment meta-analysis indicated that fluoxetine in combination with cognitive behavioural therapy (CBT) was the most effective treatment option for improving symptoms in children and adolescents with major depressive disorder. However when safety (rates of suicidal ideation and suicide attempts) and acceptability were taken into consideration, sertraline and mirtazapine were the optimal treatment options. There was no evidence on the relative effectiveness of antidepressants (other than fluoxetine) in combination with CBT. Evidence on the effects of antidepressant treatment on quality of life was inconsistent. One small, poor quality randomised controlled trial suggested that group CBT and sertraline may be similarly effective in reducing obsessive and compulsive symptoms, but that post-treatment relapse rates may be higher in this treated with sertraline, however, this finding requires confirmation by larger, high quality studies.

There appears to be a lack of research comparing the effectiveness of psychological and pharmacological interventions in children and adolescents with mental health problems other than depression.

Neither NICE or SIGN guidelines, comment on whether medication is better than psychological/ therapeutic interventions in treating mental health issues in children and young people.

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