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Pädiatrie up2date 2015; 10(04): 343-362
DOI: 10.1055/s-0041-103530
Neuropädiatrie/Psychiatrie
© Georg Thieme Verlag KG Stuttgart · New York

Depressive Störungen bei Jugendlichen: Diagnostik und Therapie[*]

Silke Naab
,
Marion Mühlberger
,
Martin Hautzinger
,
Ulrich Voderholzer
Further Information

Publication History

Publication Date:
03 December 2015 (online)

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Fazit

Aus den Leitlinien der DGKJP [1] [6] lassen sich folgende Hinweise für die Praxis ableiten:

  • Für die Diagnosestellung einer depressiven Episode bei Jugendlichen können die bei Erwachsenen gültigen Kriterien der ICD-10 (F3) herangezogen werden, auch wenn besondere Symptome für jede Altersgruppe mit einbezogen werden sollen. Zur Einteilung des Schweregrads werden immer auch das jeweilige soziale und psychische Funktionsniveau herangezogen.

  • Neben dem Einsatz von diagnostischen Verfahren geben auch fremdanamnestische Daten von Eltern und anderen Bezugspersonen und auch Verhaltensbeobachtungen Hinweise auf die Symptomatik.

  • Bei Kindern und Jugendlichen sollten vor einer Behandlung mögliche organische Ursachen der Symptome abgeklärt werden. Differenzialdiagnostisch ist v. a. der Ausschluss einer bipolaren Störung notwendig, da hier zum Teil eine andere Behandlung anzuwenden ist.

  • Bei Kindern und Jugendlichen empfiehlt sich eine Behandlung im ambulanten Setting. Eine stationäre Therapie sollte v. a. bei akuter Suizidalität und psychotischen Symptomen eingeleitet werden.

  • Psychotherapie stellt in der Behandlung depressiver Störungen bei Jugendlichen die Therapie der 1. Wahl dar. Vor allem die kognitive Verhaltenstherapie und die Interpersonelle Psychotherapie zeigen in vielen Studien eine hohe Wirksamkeit.

  • Bei schweren Verläufen oder einem Nichtansprechen auf eine Psychotherapie kann ergänzend eine psychopharmakologische Behandlung begonnen werden. Dabei haben sich v. a. selektive Serotonin-Wiederaufnahmehemmer als wirksam erwiesen. Als Mittel der 1. Wahl sollte Fluoxetin gegeben werden, das als einziges Präparat für diese Altersgruppe zugelassen ist und das niedrigste Suizidrisiko in der Phase der Eindosierung aufweist.

  • Bei vorliegender Indikation sollten auch Maßnahmen der Jugendhilfe oder andere rehabilitative Maßnahmen angedacht werden.

Aktualisierung der Erstveröffentlichung in Fortschritte der Neurologie – Psychiatrie 2015; 83: 49 – 62


 

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