Hathaway Elizabeth E, Walkup John T, Strawn Jeffrey R
Indiana University School of Medicine, Indianapolis, IN.
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Curr Probl Pediatr Adolesc Health Care. 2018 Feb;48(2):31-39. doi: 10.1016/j.cppeds.2017.12.002. Epub 2018 Jan 12.
Anxiety and depressive disorders are common in the pediatric primary care setting, and respond to both psychotherapeutic and psychopharmacologic treatment. However, there are limited data regarding the optimal treatment duration. This article systematically reviews guidelines and clinical trial data related to antidepressant treatment duration in pediatric patients with depressive and anxiety disorders. The extant literature suggests 9-12 months of antidepressant treatment for youth with major depressive disorder. For generalized, separation and social anxiety disorders, 6-9 months of antidepressant treatment may be sufficient, though many clinicians extend treatment to 12 months based on extrapolation of data from adults with anxiety disorders. Such extended treatment periods may decrease the risk of long-term morbidity and recurrence; however, the goal of treatment is ultimately remission, rather than duration of antidepressant pharmacotherapy. Moreover, while evidence-based guidelines represent a starting point, appropriate treatment duration varies and patient-specific response, psychological factors, and timing of discontinuation must be considered for individual pediatric patients.
焦虑症和抑郁症在儿科初级保健环境中很常见，并且对心理治疗和精神药物治疗均有反应。然而，关于最佳治疗持续时间的数据有限。本文系统回顾了与患有抑郁症和焦虑症的儿科患者抗抑郁药治疗持续时间相关的指南和临床试验数据。现有文献表明，患有重度抑郁症的青少年需要9至12个月的抗抑郁药治疗。对于广泛性焦虑症、分离性焦虑症和社交焦虑症，6至9个月的抗抑郁药治疗可能就足够了，不过许多临床医生根据成年焦虑症患者的数据推断，将治疗延长至12个月。这种延长的治疗期可能会降低长期发病和复发的风险；然而，治疗的最终目标是缓解，而不是抗抑郁药物治疗的持续时间。此外，虽然循证指南是一个起点，但适当的治疗持续时间因人而异，对于个体儿科患者，必须考虑患者的具体反应、心理因素以及停药时机。
