Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
Depress Anxiety. 2011 Nov;28(11):946-54. doi: 10.1002/da.20884. Epub 2011 Sep 2.
Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re-assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed.
青少年治疗抵抗性抑郁症（TRD）较为普遍且会造成损害。在此，我们综述了青少年 TRD 的定义、流行率、临床意义、风险因素和管理。与 TRD 相关的风险因素包括抑郁的特征（严重程度、绝望程度和自杀意念）、精神和医学共病、环境因素（家庭冲突、母亲抑郁和虐待史）、药代动力学和其他生物标志物。管理选项包括评估初始治疗的充分性、重新评估可能导致治疗抵抗的上述因素、换用抗抑郁药、以及药物或心理治疗增效。还综述了其他治疗方法，如电惊厥治疗、迷走神经刺激和重复经颅磁刺激。
