Academic Clinical Fellow and Specialty Registrar in Child and Adolescent Psychiatry, University of Cambridge and Hertfordshire Partnership University NHS Foundation Trust, Cambridge, UK.
Consultant Child and Adolescent Psychiatrist, Pennine Care Foundation trust and honorary reader, University of Manchester, UK.
Evid Based Ment Health. 2018 Aug;21(3):101-106. doi: 10.1136/eb-2018-102937. Epub 2018 Jul 25.
Major depressive disorder in adolescents is an important public health concern. It is common, a risk factor for suicide and is associated with adverse psychosocial consequences. The UK National Institute for Health and Care Excellence guidelines recommend that children and young people with moderate-to-severe depression should be seen within Child and Adolescent Mental Health Services and receive specific psychological interventions, possibly in combination with antidepressant medication. Cognitive behavioural therapy (in some studies) and interpersonal psychotherapy have been demonstrated to be more effective than active control treatments for depressed adolescents. For children with depression, there is some evidence that family focused approaches are more effective than individual therapy. Fluoxetine is the antidepressant with the greatest evidence for effectiveness compared with placebo. Treatment with antidepressants and/or psychological therapy is likely to reduce suicidality, although in some young people, selective serotonin reuptake inhibitors lead to increased suicidality. There is limited evidence that combination of specific psychological therapy and antidepressant medication is better than treatment with monotherapy. There are methodological limitations in the published literature that make it difficult to relate study findings to the more severely ill clinical population in Child and Adolescent Mental Health Services. Young people should have access to both evidence-based psychological interventions and antidepressants for paediatric depression. Collaborative decisions on treatment should be made jointly by young people, their carers and clinicians, taking into account individual circumstances and potential benefits, risks and availability of treatment.
青少年重度抑郁症是一个重要的公共卫生问题。它很常见，是自杀的一个风险因素，并与不良的社会心理后果有关。英国国家健康与临床优化研究所指南建议，中重度抑郁的儿童和青少年应在儿童和青少年心理健康服务机构接受治疗，并接受特定的心理干预措施，可能结合抗抑郁药物。认知行为疗法（在一些研究中）和人际心理治疗已被证明比针对抑郁青少年的积极对照治疗更有效。对于患有抑郁症的儿童，有一些证据表明，以家庭为中心的方法比个体治疗更有效。与安慰剂相比，氟西汀是最有证据表明有效的抗抑郁药。抗抑郁药和/或心理治疗可能会降低自杀风险，尽管在一些年轻人中，选择性 5-羟色胺再摄取抑制剂会导致自杀风险增加。有限的证据表明，特定心理治疗与抗抑郁药物联合治疗优于单一药物治疗。已发表的文献中存在方法学上的局限性，使得难以将研究结果与儿童和青少年心理健康服务机构中病情更严重的临床人群联系起来。患有儿科抑郁症的年轻人应同时获得基于证据的心理干预和抗抑郁药物治疗。治疗决策应在年轻人、他们的照顾者和临床医生之间共同做出，要考虑到个人情况以及治疗的潜在益处、风险和可及性。
