Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management
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DOI：
10.1542/peds.2017-4082
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发表时间：
2018-03-01
期刊：
影响因子：
8
通讯作者：
Stein, Ruth E. K.
中科院分区：
文献类型：
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作者：
Cheung, Amy H.;Zuckerbrot, Rachel A.;Stein, Ruth E. K.
目标：更新临床实践指南，以协助初级保健 (PC) 筛查和评估抑郁症。在更新指南的第二部分中，我们讨论了 PC 环境中青少年抑郁症的治疗和持续管理。方法：通过结合使用基于证据和共识的方法，指南分两个阶段更新，具体信息如下：(1) 当前的科学证据（已发表和未发表）和 (2) 指导委员会（包括有生活经验的青少年和家庭）的修订和迭代。结果：这些更新的指南有针对性 针对 10 至 21 岁的青少年，并提供 PC 中青少年抑郁症管理的建议，包括 (1) 积极监测轻度抑郁青少年，(2) 在中度和/或重度抑郁症情况下采用循证药物治疗和心理治疗方法，(3) 密切监测副作用，(4) 与心理健康专家咨询和共同管理护理，(5) 持续跟踪结果，以及 (6) 在出现以下情况时应采取的具体步骤 初始治疗开始后部分改善或无改善。总结了每项建议的强度及其证据基础的等级。结论：《初级保健青少年抑郁症指南》不能取代临床判断，并且它们不应成为青少年抑郁症管理指导的唯一来源。尽管如此，该指南可能会帮助 PC 临床医生在临床需求巨大且心理健康专家短缺的时代管理抑郁青少年。需要对 PC 中抑郁青少年的管理进行更多研究，包括指南的可用性、可行性和可持续性，以及确定指南实际改善抑郁青少年结果的程度。
OBJECTIVES: To update clinical practice guidelines to assist primary care (PC) in the screening and assessment of depression. In this second part of the updated guidelines, we address treatment and ongoing management of adolescent depression in the PC setting.METHODS: By using a combination of evidence- and consensus-based methodologies, the guidelines were updated in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) revision and iteration among the steering committee, including youth and families with lived experience.RESULTS: These updated guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in PC, including (1) active monitoring of mildly depressed youth, (2) treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression, (3) close monitoring of side effects, (4) consultation and comanagement of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and the grade of its evidence base are summarized.CONCLUSIONS: The Guidelines for Adolescent Depression in Primary Care cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist PC clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of depressed youth in PC is needed, including the usability, feasibility, and sustainability of guidelines, and determination of the extent to which the guidelines actually improve outcomes of depressed youth.