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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Depression and anxiety in children and young people

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Acute suicide or severe functional danger

Current suicidal intent or preparation, inability to maintain basic safety, psychotic depression, severe self-neglect, refusal of essential food or fluid, marked agitation, suspected abuse or rapidly worsening symptoms require same-day specialist assessment and may require emergency care.

Action: Ask directly about thoughts, intent, plans, access to means, recent acts and protective support; address immediate physical needs, remove accessible lethal means with the family where safe, obtain urgent CAMHS or emergency mental-health input, and activate safeguarding procedures when harm or exploitation is possible. Do not leave a high-risk young person without an agreed responsible adult and transfer plan.

Synopsis

Recognise developmentally expressed depression and anxiety, assess suicide, safeguarding and functional risk, distinguish normal distress from disorder, and deliver age-appropriate psychological and specialist treatment with safe antidepressant monitoring.

  • Depression in younger children may present through irritability, loss of play, somatic complaints, withdrawal, decline at school or developmental regression rather than a verbal report of sadness.
  • Anxiety becomes clinically important when fear and avoidance are persistent, disproportionate for development and impair family, school, peer or daily functioning.
  • Interview the child or young person for part of the assessment without accompanying adults when safe, while also obtaining developmental, family and school information.
  • Ask every young person with depression about self-harm, suicide, abuse, bullying, substance use, manic symptoms, psychosis and access to medication or other lethal means.
  • Psychological treatment is central; NICE social-anxiety guidance offers individual or group disorder-focused CBT and does not routinely recommend medication for children or young people.
  • Do not use antidepressants as initial treatment for mild depression; moderate-to-severe depression requires CAMHS review and developmentally appropriate psychological care.
  • When fluoxetine is indicated for depression after specialist assessment, start 10 mg daily and increase to 20 mg after one week if clinically necessary, with lower doses considered at lower body weight.
  • Monitor closely for suicidal behaviour, self-harm and hostility particularly at treatment initiation, and give the young person and carers an explicit urgent-contact route.
  • Coordinate with school only with appropriate consent or a safeguarding basis, specifying useful adjustments rather than disclosing an unrestricted clinical history.

    • Key red flags

    A specific suicide plan, preparatory behaviour, recent high-lethality self-harm, command hallucinations or stated inability to remain safe needs immediate senior assessment.

    Psychotic symptoms, manic features, severe agitation, catatonic change or profound functional collapse requires urgent specialist diagnostic review before routine depression treatment.

    Marked weight loss, dehydration, prolonged school absence, inability to get out of bed or loss of basic self-care indicates severity even when symptom words are limited.

    Bruising, sexualised behaviour, coercion, online exploitation, domestic abuse, fear of going home or a controlling accompanying adult must trigger private safeguarding enquiry.

    New suicidal behaviour, self-harm or hostility after starting or changing an antidepressant requires urgent prescriber contact and reassessment rather than automatic discontinuation or reassurance.

    Investigation priorities

    01
    Developmental mental-health interviewFirst step

    Characterise mood, anxiety, behaviour, cognition, physical symptoms, duration and impairment in age-appropriate language.

    Management branches

    Initial assessmentSee the child and the context

    Persistent low mood, irritability, fear, avoidance or functional change raises concern for depression or anxiety.

    1. Explain confidentiality and its limits, speak with the child or young person directly and privately for part of the encounter when safe.
    2. Assess syndrome, development, function, physical health, self-harm, suicide, mania, psychosis, substance use, neurodevelopment and safeguarding.
    3. Share a formulation and agree care intensity, family involvement, school liaison and explicit escalation routes based on needs rather than a score alone.

    Key medicines

    Fluoxetine for depressive illnessChildren and young people: start 10 mg orally once daily; increase to 20 mg once daily after 1 week if clinically necessary. Consider a lower dose in children of lower body weight; evidence above 20 mg daily is limited and any higher dose requires specialist justification. After response, continue for at least 6 months after remission, defined by NICE as no symptoms and full functioning for at least 8 weeks, then stop gradually under specialist guidance.Monitor suicidal behaviour, self-harm, hostility, activation, sleep and adherence particularly early; NICE gives weekly contact for the first 4 weeks as an example, with frequency individualised and recorded. Review bipolar or psychotic features, interactions and overdose access; evidence in ages 5 to 11 is not established, use under age 8 may be off label, and abrupt cessation should be avoided.
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    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • NICE NG134 depression in children recommendationsAssessment, psychological treatment, specialist prescribing, fluoxetine dose and monitoring.
    • NICE CG159 social anxiety recommendationsRecognition and CBT for children and young people, with medication not routinely offered.
    • NICE NG225 self-harm recommendationsSafety assessment, formulation and aftercare where depression or anxiety includes self-harm.
    • NHS anxiety in children informationDevelopmental symptoms, impact and routes to help.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom