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Depressive Störungen

Stellenwert psychotherapeutischer Verfahren

Affective disorders

The significance of psychotherapeutic approaches

  • Leitthema
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Zusammenfassung

Der Einsatz psychotherapeutischer Verfahren bei der Behandlung depressiver Störungen gilt heutzutage als unverzichtbar. Psychotherapien erwiesen sich bei leichten bis mittelschweren Depressionen als mindestens gleichwertig effektiv wie eine Pharmakotherapie, bei schweren und chronischen Depressionen gilt die Kombination beider Therapieformen als leitlinienempfohlene Standardbehandlung. Psychotherapeutische Ansätze weisen zwar eine längere Wirklatenz auf als Antidepressiva, wirken jedoch nachhaltiger. Da hinsichtlich der Effektivität von den im Handel befindlichen sowie in der Entwicklung stehenden Antidepressiva eher ernüchternde Ergebnisse publiziert wurden, gilt der Weiterentwicklung psychologischer Behandlungsansätze derzeit besondere Aufmerksamkeit.

Die kognitive Verhaltenstherapie und die interpersonelle Psychotherapie können die höchste Evidenzstufe nachweisen, bei psychodynamischen Verfahren ist die Studienlage noch begrenzt. Bei chronischer Depression gewinnt eine neuere störungsspezifische Psychotherapie – das „cognitive behavioral analysis system of psychotherapy“ – zunehmend an Bedeutung.

Insgesamt geht der Trend zu einer zunehmenden Spezifizierung der Therapie für umschriebene Zielgruppen. Herausforderungen für die Zukunft bestehen in der Steigerung der Effizienz, der weiteren Erforschung von Wirkmechanismen und Prädiktoren für eine differenzielle Indikation und schließlich darin, die wirksamen Psychotherapiemethoden für Patienten allgemein zugänglich zu machen.

Summary

The use of psychotherapeutic strategies is essential in the treatment of affective disorders. Psychotherapy proved to be at least equivalent to antidepressant medication in the treatment of mild to moderate depression. In severe cases, the combination of both treatments is considered by guidelines to be the standard treatment. Psychotherapeutic approaches show a longer latency than antidepressants; however, the effects are longer lasting. Regarding the effectiveness of pharmacotherapy sobering results have been published recently. Therefore, the further development of psychotherapy deserves special attention.

Cognitive behavioral therapy and interpersonal therapy provide the highest evidence. The empirical basis for psychodynamic psychotherapies is still limited. In the treatment of chronic depression a new approach – cognitive behavioral analysis system of psychotherapy – is gaining importance.

There is a trend towards an increasing specification of psychotherapy for distinct subgroups of depressed patients. Challenges for the future include increasing treatment efficacy, investigating mechanisms of efficacy and predictors for a differential indication, and making effective approaches generally available to all patients.

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Berger, M., Brakemeier, E., Klesse, C. et al. Depressive Störungen. Nervenarzt 80, 540–555 (2009). https://doi.org/10.1007/s00115-008-2624-x

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