Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universität Ulm. Steinhövelstrasse 5, Ulm, Germany.
Dtsch Arztebl Int. 2008 Feb;105(9):149-55. doi: 10.3238/arztebl.2008.0149. Epub 2008 Feb 29.
Prevalence rates for depression in children and adolescents are estimated up to 8.9%. Symptoms in this age group are different from those of depression in adults. Both neurobiological and psychosocial factors are involved in its development.
Selective literature review.
Of note are both the high rate of spontaneous remissions in childhood (33%), and the high rate of depressions continuing into adulthood (80%). In addition far fewer evidence based treatments are available than for adults. Fluoxetine is currently the only medication licensed for use in children and adolescents for this indication. Tri- and tetracyclic antidepressants have not been shown in meta-analyses to be effective in children and adolescents. Most antidepressants lead to age related side effects, including attention deficit and in particular behavioral toxicity, which has to be taken seriously wherever there is a suicide risk.
The treatment of depression in childhood and adolescence should be based on multimodal interventions including psychotherapy, including cognitive behavioral therapy, which has proven effectiveness, psychosocial interventions and medications in severe cases. Patients with severe depression, especially suicidal minors, should be treated in patients units.
儿童和青少年的抑郁症患病率估计高达 8.9%。该年龄段的症状与成年人的抑郁症不同。其发展涉及神经生物学和心理社会因素。
选择性文献回顾。
值得注意的是，儿童的自发性缓解率很高（33%），且抑郁症持续到成年的比例很高（80%）。此外，针对儿童的循证治疗方法比针对成人的要少得多。氟西汀是目前唯一被批准用于该适应证的儿童和青少年用药。三环和四环抗抑郁药在荟萃分析中并未显示对儿童和青少年有效。大多数抗抑郁药会导致与年龄相关的副作用，包括注意力缺陷，特别是行为毒性，这在存在自杀风险的情况下必须认真对待。
儿童和青少年抑郁症的治疗应基于包括心理治疗（包括已被证明有效的认知行为疗法）、心理社会干预和严重病例药物治疗在内的多模式干预。有严重抑郁症的患者，尤其是有自杀倾向的未成年人，应在患者病房中进行治疗。
