Child & Youth Mental Health Algorithm - GPSC

PSP Child and Youth Mental Health –Initiating and Monitoring Antidepressants Medication in Children /YouthFluoxetineMDD Diagnosis(DSM‐IV criteria)Use PST andMEP throughoutthe treatmentprocess.Initiate PST for at least 3 visits.KADS > 6, symptoms continue causingdistress and TeFA shows decrease infunction. Time to start medication!Measurefunctioning usingTeFA and sideeffects usingsCKS in every Begin Fluoxetine at 10 mg daily for 1 ‐ 2weeks. (If significant anxiety symptomsare present, start with 5 mg for 2 weeksand continue increasing as indicated.)Increase Fluoxetine to 20 mg daily for oneto two weeks. (Could be a split dose ifbetter tolerated.) Continue Fluoxetine at 20 mg daily for 8weeks.(If side effects are a problem – decreasethe dose to 15 mg daily for 1 week andthen increase to 20 mg. If substantial sideeffects occur, continue the dose at 15 mgfor 8 weeks.) If symptoms have not improved after 8weeks of treatment, increase the dosageby 10 mg every 2 weeks to a maximum of40mg.If you have reached the maximum doseand depressive symptoms continue tocause distress and dysfunction or there issuicidal risk REFER TO A MENTAL HEALTHSPECIALISTAtypical antipsychotics arenot meant to be used to treatdepression in primary healthcare.