Weller R A, Weller E B
Hillside J Clin Psychiatry. 1986;8(1):46-55.
Other studies have reported the use of TCA antidepressants in the treatment of depressed children (Frommer 1967; Ossofsky 1974; Stack 1972; Polvan and Cebiroglu 1972). However, these studies did not meet criteria for inclusion in this review. In studies, other medicines were given concurrently with TCAs. Several did not specify the number of subjects and/or the number who responded. Sometimes subjects who were not diagnosed as depressed were included. Also studies of childhood depression tend to include adolescents; thus many samples were a mixture of adolescents and prepubertal children with the adolescents frequently predominating. As the purpose of this review was depression in prepubertal children, only studies comprised predominantly of prepubertal children were included. Although not included in this review, many such studies reported TCAs were useful in treating depression in children. After reviewing these studies, it is obvious that their sophistication has improved dramatically in recent years. Standard diagnostic criteria such as Feighner's Research Diagnostic Criteria, the Research Diagnostic Criteria, and more recently DSM-III (all of which are similar) have permitted a more objective and standardized diagnosis of depression. Likewise, the development of the Children's Depression Inventory and the Childhood Depression Rating Scale have allowed more objective measurement of severity of depression and of improvement in depression in children. Plasma drug level monitoring has allowed for pharmacokinetic studies of TCAs, more precise dose adjustment and equivalent drug treatment of subjects involved in clinical research studies. Studies to date indicate TCAs were helpful in treating depressed prepubertal children. However, double-blind placebo/control studies of tricyclic antidepressants in depressed prepubertal school-aged children have not been published. Ideally a study of antidepressants in children should include: objective standardized diagnostic criteria for diagnosing depression; objective rating of severity of depression; explicit exclusion criteria; steady-state plasma blood level monitoring; assured compliance; adequate duration of treatment so sufficient time is allowed for response to occur; a double-blind study design. Unfortunately the ideal study has not been done. TCAs may be an effective treatment for prepubertal major depressive disorder. However, further study is necessary to clearly establish their efficacy.
其他研究报告了三环类抗抑郁药用于治疗抑郁儿童的情况（弗罗默，1967年；奥索夫斯基，1974年；斯塔克，1972年；波尔万和塞比罗格鲁，1972年）。然而，这些研究不符合本综述的纳入标准。在这些研究中，其他药物与三环类抗抑郁药同时使用。有几项研究未具体说明受试者的数量和/或有反应者的数量。有时还纳入了未被诊断为抑郁的受试者。此外，儿童抑郁症的研究往往包括青少年；因此，许多样本是青少年和青春期前儿童的混合体，其中青少年通常占主导。由于本综述的目的是研究青春期前儿童的抑郁症，所以仅纳入了主要由青春期前儿童组成的研究。尽管未纳入本综述，但许多此类研究报告称三环类抗抑郁药对治疗儿童抑郁症有用。在回顾这些研究后，很明显近年来它们的复杂性有了显著提高。标准诊断标准，如费伊纳研究诊断标准、研究诊断标准以及最近的《精神疾病诊断与统计手册》第三版（所有这些都相似），使得对抑郁症的诊断更加客观和标准化。同样，儿童抑郁量表和儿童抑郁评定量表的发展使得能够更客观地测量儿童抑郁症的严重程度以及抑郁症状的改善情况。血浆药物水平监测使得能够对三环类抗抑郁药进行药代动力学研究、更精确地调整剂量以及对参与临床研究的受试者进行等效药物治疗。迄今为止的研究表明三环类抗抑郁药对治疗青春期前抑郁儿童有帮助。然而，关于三环类抗抑郁药在青春期前学龄抑郁儿童中的双盲安慰剂/对照研究尚未发表。理想情况下，儿童抗抑郁药研究应包括：用于诊断抑郁症的客观标准化诊断标准；抑郁症严重程度的客观评定；明确的排除标准；稳态血浆血药水平监测；确保依从性；足够的治疗时长以便有足够时间产生反应；双盲研究设计。不幸的是，尚未进行理想的研究。三环类抗抑郁药可能是治疗青春期前重度抑郁症的有效方法。然而，需要进一步研究以明确确定它们的疗效。
