Luby Joan L
Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, Box 8134, St. Louis, MO 63110, USA.
Am J Psychiatry. 2009 Sep;166(9):974-9. doi: 10.1176/appi.ajp.2009.08111709.
Although empirical evidence has recently validated clinical depression in children as young as age 3, few data are available to guide treatment of early childhood depression. Considering this gap in the literature, a novel dyadic psychotherapeutic model, Parent Child Interaction Therapy-Emotion Development, based on a well-known and effective manualized treatment for disruptive preschoolers, is currently being tested for use in depression. To balance safety and efficacy, dyadic developmental approaches are currently recommended as the first line of treatment for preschool depression. In the absence of data on the safety and efficacy of antidepressants in preschool depression, these agents are not recommended as a first- or second-line treatment at this time. This article provides an illustrative case example of preschool depression, outlines key considerations in differential diagnosis, and describes this novel form of treatment. It also clarifies parameters for the rare situations in which antidepressants may be tried when psychotherapeutic options fail and depression is severe and impairing.
尽管最近的实证证据证实了年仅3岁的儿童也会患临床抑郁症，但目前几乎没有数据可用于指导幼儿抑郁症的治疗。鉴于文献中的这一空白，一种新的二元心理治疗模式——亲子互动疗法-情绪发展，基于一种针对有破坏性行为的学龄前儿童的著名且有效的手册化治疗方法，目前正在进行抑郁症治疗的测试。为了平衡安全性和有效性，目前推荐二元发展方法作为学龄前抑郁症的一线治疗方法。由于缺乏关于抗抑郁药在学龄前抑郁症中的安全性和有效性的数据，目前不建议将这些药物作为一线或二线治疗方法。本文提供了一个学龄前抑郁症的实例，概述了鉴别诊断中的关键考虑因素，并描述了这种新的治疗形式。它还阐明了在心理治疗选择失败且抑郁症严重且有损害时可能尝试使用抗抑郁药的罕见情况下的参数。
