Pfalzgraf Andrea R, Scott Virginia, Makela Eugene, Kavookjian Jan, Hartsock Steven L, Miller Lesley-Ann
Mylan School of Pharmacy, Division of Clinical, Social, and Administrative Sciences, Duquesne University, Pittsburgh, PA 15282, USA.
J Psychiatr Pract. 2012 Jul;18(4):253-61. doi: 10.1097/01.pra.0000416015.60838.a5.
Major depressive disorder (MDD) is a serious U.S. public health problem for children and adolescents. This study examined the type and course of treatment and monitoring habits of child psychiatrists treating newly diagnosed children and adolescents with MDD. Length of treatment and monitoring frequency were compared to current recommendations.
A national random sample of child psychiatrists (N = 2,250) was surveyed via a modified Dillman approach to mailed surveys. Descriptive statistics and t-tests were used to report and analyze the data.
Of 1,982 surveys that were delivered to child psychiatrists, 316 (15.9%) were returned, with 299 surveys (15.1%) providing usable data. The child psychiatrists who responded to the survey reported that they use a combination of antidepressant and psychotherapy treatment, although many (40.1%) treat children with psychotherapy alone as a first-line treatment. With regard to pharmacotherapy for MDD, the child psychiatrists self-reported using fluoxetine or sertraline. Many child psychiatrists also use bupropion or other drug classes as a third-line treatment strategy. The child psychiatrists reported that they treat children and adolescents with antidepressant medication for an average of 10 months. This is significantly (p < 0.05) longer than the 6 month minimum recommended by the American Academy of Child and Adolescent Psychiatry (AACAP). During the first and second months of treatment, the monitoring reported was significantly (p < 0.05) less than that recommended by the U.S. Food and Drug Administration (FDA), while the reported monitoring did not differ (p = 0.10) from FDA recommendations in the third month.
Child psychiatrists reported using combination treatment when treating children and adolescents with MDD. When they reported using antidepressant medications, the most commonly prescribed agents were fluoxetine or sertraline. Reported length of antidepressant treatment was adequate for relapse prevention. The monitoring behavior reported by respondents was not consistent with the FDA's recommendations for the first 2 months of treatment, but it was consistent for month 3.
重度抑郁症（MDD）是美国儿童和青少年面临的一个严重公共卫生问题。本研究调查了治疗新诊断的患有MDD的儿童和青少年的儿童精神科医生的治疗类型、过程以及监测习惯。将治疗时长和监测频率与当前建议进行了比较。
采用改良的迪尔曼邮寄调查法，对全国范围内随机抽取的2250名儿童精神科医生进行了调查。使用描述性统计和t检验来报告和分析数据。
在发放给儿童精神科医生的1982份调查问卷中，316份（15.9%）被退回，其中299份（15.1%）提供了可用数据。回复调查的儿童精神科医生报告称，他们采用抗抑郁药和心理治疗相结合的方法，不过许多医生（40.1%）将单独使用心理治疗作为治疗儿童的一线方法。关于MDD的药物治疗，儿童精神科医生自我报告使用氟西汀或舍曲林。许多儿童精神科医生还将安非他酮或其他药物类别作为三线治疗策略。儿童精神科医生报告称，他们使用抗抑郁药物治疗儿童和青少年的平均时长为10个月。这明显长于美国儿童和青少年精神病学会（AACAP）建议的最短6个月（p<0.05）。在治疗的第一个月和第二个月，报告的监测明显少于美国食品药品监督管理局（FDA）的建议（p<0.05），而在第三个月报告的监测与FDA的建议没有差异（p=0.10）。
儿童精神科医生报告在治疗患有MDD的儿童和青少年时采用联合治疗。当他们报告使用抗抑郁药物时，最常开具的药物是氟西汀或舍曲林。报告的抗抑郁治疗时长足以预防复发。受访者报告的监测行为在治疗的前两个月与FDA的建议不一致，但在第三个月是一致的。
