Remarks y The effects of antidepressants might vary between individuals, so the adolescents, their carers and clinicians should carefully balance the risk–benefit profile of efficacy, acceptability and suicide risk in young people with depression on a case-by-case basis. y It is important to inform adolescents and carers, as appropriate, about treatment options and jointly reassess treatment goals and management plans on a regular basis.

Implementation considerations y Access to psychotherapy, particularly CBT, in line with other mhGAP recommendations, remains important for adolescents with moderate-to-severe depression. y In case psychosocial interventions alone prove ineffective, the adolescent and the caregiver, as appropriate, should be referred to a specialist for careful consideration of benefits and risks associated with initiation of fluoxetine, possibly in combination with psychological treatment, in close consultation with the adolescent and family, as appropriate. y Fluoxetine treatment should be offered only in the context of a management plan that addresses psychosocial risks and vulnerabilities and environmental factors that have an impact on depression symptoms and functioning. y Adolescents receiving fluoxetine should be maintained under close clinical monitoring for improvement in symptoms and prevention of adverse effects. y A specialist care provider should reassess the adolescent’s management plan at least once per year.