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?
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
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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