Menculini Giulia, Cinesi Gianmarco, Scopetta Francesca, Cardelli Matteo, Caramanico Guido, Balducci Pierfrancesco Maria, De Giorgi Filippo, Moretti Patrizia, Tortorella Alfonso
Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Community Mental Health Center "CSM Terni", Department of Psychiatry, Local Health Unit USL Umbria 2, Terni, Italy.
Front Psychiatry. 2024 Jul 11;15:1417977. doi: 10.3389/fpsyt.2024.1417977. eCollection 2024.
Major depressive disorder (MDD) represents a major health issue in adolescents and young adults, leading to high levels of disability and profoundly impacting overall functioning. The clinical presentation of MDD in this vulnerable age group may slightly differ from what can be observed in adult populations, and psychopharmacological strategies do not always lead to optimal response. Resistance to antidepressant treatment has a prevalence estimated around 40% in youths suffering from MDD and is associated with higher comorbidity rates and suicidality. Several factors, encompassing biological, environmental, and clinical features, may contribute to the emergence of treatment-resistant depression (TRD) in adolescents and young adults. Furthermore, TRD may underpin the presence of an unrecognized bipolar diathesis, increasing the overall complexity of the clinical picture and posing major differential diagnosis challenges in the clinical practice. After summarizing current evidence on epidemiological and clinical correlates of TRD in adolescents and young adults, the present review also provides an overview of possible treatment strategies, including novel fast-acting antidepressants. Despite these pharmacological agents are promising in this population, their usage is expected to rely on risk-benefit ratio and to be considered in the context of integrated models of care.
重度抑郁症（MDD）是青少年和青年中的一个重大健康问题，会导致高度残疾并对整体功能产生深远影响。在这个脆弱的年龄组中，MDD的临床表现可能与成人有所不同，而且心理药理学策略并不总能带来最佳反应。在患有MDD的青少年中，对抗抑郁治疗的抵抗发生率估计约为40%，并且与更高的共病率和自杀倾向相关。包括生物学、环境和临床特征在内的几个因素，可能导致青少年和青年出现难治性抑郁症（TRD）。此外，TRD可能是未被识别的双相素质存在的基础，增加了临床情况的整体复杂性，并在临床实践中带来了重大的鉴别诊断挑战。在总结了目前关于青少年和青年TRD的流行病学和临床相关性的证据后，本综述还概述了可能的治疗策略，包括新型速效抗抑郁药。尽管这些药物在该人群中有前景，但预计它们的使用将依赖于风险效益比，并在综合护理模式的背景下加以考虑。
