University of Mississippi Medical Center, Jackson, MS 39216, USA.
Am Fam Physician. 2012 Sep 1;86(5):442-8.
Major depressive disorder in children and adolescents is a common condition that affects physical, emotional, and social development. Risk factors include a family history of depression, parental conflict, poor peer relationships, deficits in coping skills, and negative thinking. Diagnostic criteria are the same for children and adults, with the exception that children and adolescents may express irritability rather than sad or depressed mood, and weight loss may be viewed in terms of failure to reach appropriate weight milestones. Treatment must take into account the severity of depression, suicidality, developmental stage, and environmental and social factors. Cognitive behavior therapy and interpersonal therapy are recommended for patients with mild depression and are appropriate adjuvant treatments to medication in those with moderate to severe depression. Pharmacotherapy is recommended for patients with moderate or severe depression. Tricyclic antidepressants are not effective in children and adolescents. Antidepressants have a boxed warning for the increased risk of suicide; therefore, careful assessment, follow-up, safety planning, and patient and family education should be included when treatment is initiated.
儿童和青少年的重性抑郁障碍是一种常见疾病，会影响身体、情感和社会发展。危险因素包括抑郁家族史、父母冲突、不良同伴关系、应对技能缺陷和消极思维。儿童和成人的诊断标准相同，只是儿童和青少年可能表现为易怒而不是悲伤或抑郁情绪，体重减轻可能被视为未能达到适当的体重里程碑。治疗必须考虑到抑郁的严重程度、自杀倾向、发育阶段以及环境和社会因素。对于轻度抑郁患者，建议采用认知行为疗法和人际治疗，对于中重度抑郁患者，这些方法可作为药物治疗的辅助手段。对于中重度抑郁患者，建议药物治疗。三环类抗抑郁药对儿童和青少年无效。抗抑郁药有增加自杀风险的黑框警告；因此，在开始治疗时，应包括仔细评估、随访、安全计划以及对患者和家属进行教育。
