THERAPY IN PRACTICE Management of Treatment-Resistant Depression in Children and Adolescents Melissa DeFilippis • Karen Dineen Wagner Published online: 9 September 2014 Ó Springer International Publishing Switzerland 2014 Abstract Depression is a relatively common diagnosis in children and adolescents, and is associated with significant morbidity and suicidality in this population. Evidence- based treatment of the acute illness is imperative to try to prevent the development of treatment-resistant depression or other complications. In situations where response to acute treatment is inadequate, clinicians should first con- sider factors that may influence outcome, such as psychi- atric or medical comorbidities, psychosocial stressors, and treatment noncompliance. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression in children and adolescents. For treatment-resistant depression, a switch to an alternate SSRI is recommended before trials of other antidepressants. Psychotherapy, such as cognitive behavioral therapy or interpersonal therapy, may improve treatment response. More research is needed examining medication augmentation strategies for treat- ment-resistant depression in children and adolescents. Key Points Treatment-resistant depression is a significant problem within the child and adolescent population. Evidence-based acute treatment is important to help prevent the occurrence of treatment-resistant depression. Psychotherapy may provide additional benefit when used in combination with medication for adolescents with treatment-resistant depression. Guidelines have been developed to help aide clinicians in treatment decisions; however, more research is needed in the area of treatment-resistant depression in children and adolescents. 1 Introduction Major depressive disorder is a fairly common diagnosis in the pediatric population. The National Comorbidity Sur- vey-Adolescent Supplement (NCS-A), a US survey, showed a lifetime prevalence of major depression or dys- thymia in 12 % of adolescents surveyed, aged 13–18 years [1]. Depression was about twice as prevalent in females as males, and prevalence increased with age (8 % in 13–14 year olds and 15 % in 17–18 year olds). A natu- ralistic, follow-up study of depressed adolescents into young adulthood examined the outcome of adolescent depression [2]. This study included 140 adolescents with major depressive disorder, dysthymic disorder, or depres- sive disorder not otherwise specified who underwent M. DeFilippis Á K. D. Wagner (&) Department of Child and Adolescent Psychiatry, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0188, USA e-mail: kwagner@utmb.edu M. DeFilippis e-mail: msdefili@utmb.edu Pediatr Drugs (2014) 16:353–361 DOI 10.1007/s40272-014-0088-y