J Am Acad Child Adolesc Psychiatry. 1998 Oct;37(10 Suppl):63S-83S. doi: 10.1097/00004583-199810001-00005.
Child and adolescent major depressive disorder and dysthymic disorder are common, chronic, familial, and recurrent conditions that usually persist into adulthood. These disorders appear to be manifesting at an earlier age in successive cohorts and are usually accompanied by comorbid psychiatric disorders, increased risk for suicide, substance abuse, and behavior problems. In addition, depressed youth frequently have poor psychosocial, academic, and family functioning, which highlights the importance of early identification and prompt treatment. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of youth with depressive disorders. Opinions vary regarding which of these treatments should be offered first and whether they should be offered in combination. In general, the choice of initial therapy depends on clinical and psychosocial factors and therapist's expertise. Based on the current literature and clinical experience, psychotherapy may be the first treatment for most depressed youth. However, antidepressants must be considered for those patients with psychosis, bipolar depression, severe depressions, and those who do not respond to an adequate trial of psychotherapy. All patients need continuation therapy and some patients may require maintenance treatment. Further research is needed on the etiology of depression; the efficacy of different types of psychotherapy; the differential effects of psychotherapy, pharmacotherapy, and integrated therapies; the continuation and maintenance treatment phases; treatment for dysthymia, treatment-resistant depression, and other subtypes of major depressive disorder; and preventive strategies for high-risk children and adolescents.
儿童和青少年重度抑郁症及心境恶劣障碍是常见、慢性、具有家族性且易复发的病症，通常会持续至成年期。这些病症在连续几代人群中似乎发病年龄越来越早，并且通常伴有共病性精神障碍、自杀风险增加、物质滥用及行为问题。此外，抑郁的青少年往往在心理社会、学业及家庭功能方面表现不佳，这凸显了早期识别和及时治疗的重要性。心理治疗和药物治疗均已被证实对患有抑郁症的青少年的急性治疗有益。对于应首先提供哪种治疗以及是否应联合提供这些治疗，存在不同观点。一般而言，初始治疗的选择取决于临床和心理社会因素以及治疗师的专业知识。根据当前的文献和临床经验，心理治疗可能是大多数抑郁青少年的首选治疗方法。然而，对于患有精神病、双相抑郁症、重度抑郁症的患者以及对充分的心理治疗试验无反应的患者，必须考虑使用抗抑郁药。所有患者都需要持续治疗，部分患者可能需要维持治疗。关于抑郁症的病因、不同类型心理治疗的疗效、心理治疗、药物治疗及综合治疗的差异效应、持续治疗和维持治疗阶段、心境恶劣障碍的治疗、难治性抑郁症及重度抑郁症其他亚型的治疗以及高危儿童和青少年的预防策略，还需要进一步研究。
