Department of Psychiatry, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Res Dev Disabil. 2011 Sep-Oct;32(5):1432-40. doi: 10.1016/j.ridd.2011.02.010. Epub 2011 Mar 10.
Depression has been frequently reported in individuals with Down Syndrome (DS). The aim of this article is to provide a comprehensive, critical review of the clinically relevant literature concerning depression in DS, with a focus on epidemiology, potential risk factors, diagnosis, course characteristics and treatment.
We searched the PUBMED database (January 2011) using the keywords ("Depressive Disorder [MESH]" OR "Depression [MESH]" OR "depress* [All Fields]") AND ("Down Syndrome [MESH]" OR "Down syndrome [All Fields]" OR "Down's syndrome [All Fields]"). Review articles not adding new information, single case reports and papers focusing on subjects other than depression in DS were excluded.
The PUBMED search resulted in 390 articles, of which 30 articles were finally included. Recent information does not support earlier suggestions of an increased prevalence of depression in DS compared to other causes of Intellectual Disability (ID). However, individuals with DS show many vulnerabilities and are exposed to high levels of stressors that could confer an increased risk for the development of depression. Apart from general risk factors, several potential risk factors are more specific for DS, including smaller hippocampal volumes, certain changes in neurotransmitter systems, deficits in language and working memory, attachment behaviours and frequently occurring somatic disorders. Protective factors might play a role in reducing the vulnerability to depression. The diagnosis of depression in DS is mainly based upon observable characteristics, and therefore, the use of modified diagnostic criteria is advised. Although several common treatments, including antidepressants, electroconvulsive therapy and psychotherapy seem effective, there is evidence of undertreatment of depression in DS.
There are important limitations to our current clinical knowledge of depression in DS. Future studies should include systematic evaluations of pharmacotherapeutic and psychotherapeutic interventions.
唐氏综合征（DS）患者常伴有抑郁。本文旨在对 DS 患者抑郁的临床相关文献进行全面、批判性的综述，重点介绍流行病学、潜在风险因素、诊断、病程特征和治疗。
我们使用关键词（“Depressive Disorder [MESH]”或“Depression [MESH]”或“depress* [All Fields]”）和（“Down Syndrome [MESH]”或“Down syndrome [All Fields]”或“Down's syndrome [All Fields]”）在 PUBMED 数据库（2011 年 1 月）中进行检索。排除未提供新信息的综述文章、单病例报告和非 DS 抑郁相关的文章。
PUBMED 搜索结果为 390 篇文章，最终纳入 30 篇文章。近期的信息并不支持 DS 患者抑郁患病率高于其他智力障碍（ID）的早期观点。然而，DS 患者存在诸多脆弱性，且面临较高水平的压力源，这可能增加其患抑郁的风险。除一般风险因素外，还有一些特定于 DS 的潜在风险因素，包括海马体体积较小、某些神经递质系统的变化、语言和工作记忆缺陷、依恋行为以及常见的躯体障碍。保护因素可能在降低抑郁易感性方面发挥作用。DS 患者抑郁的诊断主要基于可观察到的特征，因此建议使用改良的诊断标准。尽管一些常见的治疗方法，包括抗抑郁药、电惊厥疗法和心理疗法似乎有效，但 DS 患者的抑郁治疗不足。
我们对 DS 患者抑郁的临床知识存在重要的局限性。未来的研究应包括对药物治疗和心理治疗干预的系统评估。
