Approach Considerations
Current evidence-supported interventions include cognitive-behavioral psychotherapy, pharmacotherapy, or a combination of both should be offered as treatment for children and adolescents with major depressive disorder (MDD). Safety is always the first concern in the evaluation of MDD in children and adolescents. Risk assessment of patients who are depressed should be ongoing. Documentation should support clinical decision-making.
Cognitive-behavioral therapy has been shown in multiple randomized, clinical trials to be effective in the treatment of mild to moderate MDDs in children and adolescents. Evidence from randomized, clinical trials suggests efficacy in the treatment of moderate to severe MDD using 3 selective serotonin reuptake inhibitors (SSRIs): fluoxetine,[38] sertraline,[39, 40] and citalopram.
Overall, the choice of the initial acute therapy depends on the following factors:
Severity
Number of prior episodes
Chronicity
Subtype
Age of the patient
Contextual issues - Eg, family conflict, academic problems, exposure to negative life events
Adherence to treatment
Previous response to treatment
Motivation of the patient and family for treatment
In mild cases, psychosocial interventions are often recommended as first-line treatments, whereas, in the more severe cases, medication in addition to psychotherapeutic intervention is often recommended.
Treatment of a child or adolescent who is depressed should occur within a biopsychosocial context. Such an approach includes the psychotherapies (eg, individual, family, group), medication management, social skills training, and educational assessment and planning. The clinician should choose a treatment setting prior to initiation of a treatment plan.
The clinician must carefully assess the risk for suicide in any child who is depressed. If a child is preoccupied with thoughts of suicide or has definite plans, or has other significant risk factors for suicide, the patient must be hospitalized. The clinician should weigh factors such as the child’s ability to function and the stability of the family, plus any history of previous suicide attempts, when determining whether or not a child or adolescent should be hospitalized.
因為太長，所以偷懶，用了一下狗狗翻譯，將就著看吧：
方法注意事項
目前的證據支持的幹預措施包括認知行為心理治療，藥物治療，或兩者的結合，應提供作為治療兒童和青少年重度抑鬱症（MDD）。安全始終是抑鬱症的兒童和青少年的評價首先關注的。病人的風險評估誰是鬱悶應該是持續的。文件應支持臨床決策。
認知行為療法已被證明在多個隨機臨床試驗，可有效地治療輕度至中度的兒童和青少年MDDS。從隨機的臨床試驗證據表明療效中度使用3選擇性五羥色胺再攝取抑製劑（SSRIs）治療重度抑鬱症：氟西汀，[38]舍曲林，[39，40]和西酞普蘭。
總體而言，在初始急性治療的選擇取決於以下因素：
嚴重性
發作前的數
慢性
亞型
患者的年齡
背景問題 - 例如，家庭衝突，學術問題，暴露在負性生活事件
堅持治療
以前的治療反應
患者及家屬對治療的動機
在溫和的情況下，心理幹預通常推薦為一線治療藥物，而在更嚴重的情況下，藥物治療，除了心理治療幹預，經常被推薦。
治療兒童或青少年誰是鬱悶生物心理社會環境中應該發生的。這種方法包括心理治療（如個人，家庭，團體），藥物管理，社交技巧訓練，以及教育評估和規劃。臨床醫生應選擇處理設置之前，治療計劃的開始。
臨床醫生必須仔細評估誰按下任何一個孩子自殺的風險。如果一個孩子斤斤計較自殺的念頭或有明確的計劃，或有其他顯著危險因素自殺，病人必須住院治療。確定兒童或青少年是否應該住院治療時，臨床醫生應權衡因素，如孩子的運作能力和家庭的穩定，再加上先前的自殺企圖的任何曆史。
文章來源：http://emedicine.medscape.com/article/914192-treatment
Current evidence-supported interventions include cognitive-behavioral psychotherapy, pharmacotherapy, or a combination of both should be offered as treatment for children and adolescents with major depressive disorder (MDD). Safety is always the first concern in the evaluation of MDD in children and adolescents. Risk assessment of patients who are depressed should be ongoing. Documentation should support clinical decision-making.
Cognitive-behavioral therapy has been shown in multiple randomized, clinical trials to be effective in the treatment of mild to moderate MDDs in children and adolescents. Evidence from randomized, clinical trials suggests efficacy in the treatment of moderate to severe MDD using 3 selective serotonin reuptake inhibitors (SSRIs): fluoxetine,[38] sertraline,[39, 40] and citalopram.
Overall, the choice of the initial acute therapy depends on the following factors:
Severity
Number of prior episodes
Chronicity
Subtype
Age of the patient
Contextual issues - Eg, family conflict, academic problems, exposure to negative life events
Adherence to treatment
Previous response to treatment
Motivation of the patient and family for treatment
In mild cases, psychosocial interventions are often recommended as first-line treatments, whereas, in the more severe cases, medication in addition to psychotherapeutic intervention is often recommended.
Treatment of a child or adolescent who is depressed should occur within a biopsychosocial context. Such an approach includes the psychotherapies (eg, individual, family, group), medication management, social skills training, and educational assessment and planning. The clinician should choose a treatment setting prior to initiation of a treatment plan.
The clinician must carefully assess the risk for suicide in any child who is depressed. If a child is preoccupied with thoughts of suicide or has definite plans, or has other significant risk factors for suicide, the patient must be hospitalized. The clinician should weigh factors such as the child’s ability to function and the stability of the family, plus any history of previous suicide attempts, when determining whether or not a child or adolescent should be hospitalized.
因為太長，所以偷懶，用了一下狗狗翻譯，將就著看吧：
方法注意事項
目前的證據支持的幹預措施包括認知行為心理治療，藥物治療，或兩者的結合，應提供作為治療兒童和青少年重度抑鬱症（MDD）。安全始終是抑鬱症的兒童和青少年的評價首先關注的。病人的風險評估誰是鬱悶應該是持續的。文件應支持臨床決策。
認知行為療法已被證明在多個隨機臨床試驗，可有效地治療輕度至中度的兒童和青少年MDDS。從隨機的臨床試驗證據表明療效中度使用3選擇性五羥色胺再攝取抑製劑（SSRIs）治療重度抑鬱症：氟西汀，[38]舍曲林，[39，40]和西酞普蘭。
總體而言，在初始急性治療的選擇取決於以下因素：
嚴重性
發作前的數
慢性
亞型
患者的年齡
背景問題 - 例如，家庭衝突，學術問題，暴露在負性生活事件
堅持治療
以前的治療反應
患者及家屬對治療的動機
在溫和的情況下，心理幹預通常推薦為一線治療藥物，而在更嚴重的情況下，藥物治療，除了心理治療幹預，經常被推薦。
治療兒童或青少年誰是鬱悶生物心理社會環境中應該發生的。這種方法包括心理治療（如個人，家庭，團體），藥物管理，社交技巧訓練，以及教育評估和規劃。臨床醫生應選擇處理設置之前，治療計劃的開始。
臨床醫生必須仔細評估誰按下任何一個孩子自殺的風險。如果一個孩子斤斤計較自殺的念頭或有明確的計劃，或有其他顯著危險因素自殺，病人必須住院治療。確定兒童或青少年是否應該住院治療時，臨床醫生應權衡因素，如孩子的運作能力和家庭的穩定，再加上先前的自殺企圖的任何曆史。
文章來源：http://emedicine.medscape.com/article/914192-treatment
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