Comprehensive treatment of depression in minors

The therapeutic approach to depression in children and adolescents should always be comprehensive, personalized, and focused on both the child and their environment. This involves intervention on several fronts: psychotherapy, the careful use of psychotropic drugs when necessary, and the active participation of the family, school, and community.

Psychotherapy: the most effective types and models in childhood and adolescence

Psychotherapy is the cornerstone of depression treatment in minors. The most widely used and evidence-based approaches are cognitive behavioral therapy (CBT), interpersonal therapy, and systemic family therapy. CBT is based on identifying and modifying negative thought patterns that perpetuate the depressive state and has been shown to be particularly effective in adolescents.

Interpersonal therapy, on the other hand, helps improve social and family relationships that influence the child's emotional state. In contexts where there are dysfunctional family dynamics, systemic therapy can be key.

This approach allows depression to be addressed as part of a disrupted family system, working with all members to bring about changes in the emotional dynamics.

In some cases, especially when the child has a background of trauma or highly internalized symptoms, psychodynamic therapy can provide valuable elements, although its application requires specialized professionals and longer therapeutic processes.

In some countries, due to limitations in the healthcare system, supportive psychotherapy is often used. Although basic, it can have positive effects, especially when accompanied by a strong therapeutic bond and a supportive environment.

Psychopharmacology: criteria for use and clinical considerations

Medication should be used with great caution in children with depression and only when clinically warranted. It is mainly indicated in cases of moderate to severe depression, or when there is a risk of suicide, comorbidity with other disorders, or a poor response to psychotherapy alone.

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are the most commonly used psychotropic drugs in the pediatric population due to their safety profile. Even so, their use requires careful evaluation, constant monitoring, and very clear communication with the family.

The therapeutic effect may begin to be observed in the first few weeks, but the full response may take four to six weeks. It is essential to warn parents and caregivers that rapid improvement does not mean that treatment can be discontinued, as premature discontinuation can lead to relapse.

Family, school, and community involvement

Truly effective treatment is not limited to the therapist's office. The family must be actively involved, not only as emotional support, but also as a therapeutic agent. It is key to educate parents about the illness, demystify misconceptions, and strengthen their ability to provide a safe, empathetic, and stable environment.

Schools, for their part, have a decisive role to play. Teachers and administrators need to understand the implications of depression on student academic performance and social behavior.

Flexibility in school requirements and the promotion of a stigma-free environment are essential. It is also recommended that communication be established between the health team and the educational institution to ensure continuity of support.

Finally, the community must be part of the care process, especially in vulnerable contexts. Cultural, sports, and recreational spaces can serve as protective networks, reducing isolation and strengthening children's self-esteem. Only with a coordinated and sensitive approach can effective and sustained recovery be guaranteed.