Oregon Health and Sciences University, Portland, OR, USA.
Am Fam Physician. 2019 Nov 15;100(10):609-617.
The prevalence of major unipolar depression in children and adolescents is increasing in the United States. In 2016, approximately 5% of 12-year-olds and 17% of 17-year-olds reported experiencing a major depressive episode in the previous 12 months. Screening for depression in adolescents 12 years and older should be conducted annually using a validated instrument, such as the Patient Health Questionnaire-9: Modified for Teens. If the diagnosis is confirmed, treatment should be initiated for persistent, moderate, and severe depression. Active support and monitoring may be sufficient for mild, self-limited depression. For more severe depression, evidence indicates greater response to treatment when psychotherapy (e.g., cognitive behavior therapy) and an antidepressant are used concurrently, compared with either treatment alone. Fluoxetine and escitalopram are the only antidepressants approved by the U.S. Food and Drug Administration for treatment of depression in children and adolescents. Fluoxetine may be used in patients older than eight years, and escitalopram may be used in patients 12 years and older. Monitoring for suicidality is necessary in children and adolescents receiving pharmacotherapy, with frequency of monitoring based on each patient's individual risk. The decision to modify treatment (add, increase, change the medication or add psychotherapy) should be made after about four to eight weeks. Consultation with or referral to a mental health subspecialist is warranted if symptoms worsen or do not improve despite treatment and for those who become a risk to themselves or others.
美国儿童和青少年重度单相抑郁症的患病率呈上升趋势。2016 年，约 5%的 12 岁儿童和 17%的 17 岁儿童报告在过去 12 个月中经历过重度抑郁发作。应使用经过验证的工具（如青少年版患者健康问卷-9）每年对 12 岁及以上青少年进行抑郁筛查。如果确诊，应针对持续、中度和重度抑郁症启动治疗。对于轻度、自限性抑郁症，积极的支持和监测可能就足够了。对于更严重的抑郁症，有证据表明，与单独使用一种治疗方法相比，同时使用心理治疗（如认知行为疗法）和抗抑郁药治疗时，患者的反应更好。氟西汀和依地普仑是美国食品和药物管理局批准用于治疗儿童和青少年抑郁症的唯一两种抗抑郁药。氟西汀可用于 8 岁以上的患者，依地普仑可用于 12 岁及以上的患者。在儿童和青少年接受药物治疗时，必须监测自杀意念，监测频率取决于每个患者的个体风险。大约在四到八周后，应根据患者的情况决定是否调整治疗方案（添加、增加、改变药物或增加心理治疗）。如果症状恶化或治疗后没有改善，或者患者对自己或他人构成风险，应咨询或转介给精神科专家。
