Zusammenfassung
Die allgemeine Wirksamkeit psychotherapeutischer Ansätze bei der Behandlung psychiatrischer Störungen ist durch Metaanalysen gesichert. Dabei haben sich störungsorientierte Verfahren zunehmend durchgesetzt. Bei leichten und mittelschweren Depressionen erwiesen sich psychologische Ansätze gleichermaßen effektiv wie Pharmakotherapie, jedoch nachhaltiger wirksam nach Therapieende. Die Kombinationsbehandlung hat einen hohen Stellenwert bei schweren und chronischen Depressionen. Über den Schweregrad und Verlaufstyp hinaus sollte die Indikation weiter differenziert werden, z. B. nach dem Vorliegen früher Traumatisierungen, Komorbidität, Patientenschwierigkeit sowie der wissenschaftlichen Absicherung des gewählten Verfahrens.
Summary
The general efficacy of psychotherapeutic approaches in the treatment of mental disorders has been demonstrated by meta-analyses. Disorder-specific methods are increasingly dominating the field. In the field of depression psychological interventions have proven to be as equally effective as pharmacotherapy in mild and moderate depressives but with longer lasting effects after termination of treatment. The combination of both methods is particularly relevant for the therapy of severe and chronic depression. The indications should be differentiated beyond the severity and course of the disorder, e.g. according to previous traumatization, comorbidity, patient difficulty and the empirical evidence of the different approaches.
Literatur
Berger M, Schramm E (2004) Psychotherapie in der Psychiatrie – Herz oder Appendix? Psychother Prax 4(3):140–145
Cuijpers P, Straten A van, Andersson G et al (2008) Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 76(6):909–922
Cuijpers P, Straten A van, Warmerdam L, Andersson G (2009) Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety 26(3):279–288
Cuijpers P, Straten A van, Hollon SD, Andersson G (2010) The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression: a meta-analysis. Acta Psychiatr Scand 121(6):415–423
Cuijpers P, Smit F, Bohlmeijer E et al (2010) Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry 196:173–178
Cuijpers P, Geraedts AS, Oppen P van et al (2011) Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry (Epub ahead of print)
Driessen E, Cuijpers P, Maat SCM de et al (2010) The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev 30(1):25–36
DeRubeis RJ, Hollon SD, Amsterdam JD et al (2005) Cognitive therapy vs. medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 62:409–416
DeRubeis RJ, Siegle GJ, Hollon SD (2008) Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nat Rev Neurosci 9(10):788–796
Elkin I (1994) The NIMH treatment of depression collaborative research program: where we began and where we are. In: Bergin AE, Garfield SL (Hrsg) Handbook of psychotherapy and behaviour change, 4. Aufl. Wiley, New York
Frank E, Cassano GB, Rucci P et al (2011) Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychol Med 41:151–162
Gerber AJ, Kocsis JH, Milrod BL et al (2011) A quality-based review of randomized controlled trials of psychodynamic psychotherapy. Am J Psychiatry 168(1):19–28
Gloaguen V, Cottraux J, Cucherat M, Blackburn I (1998) A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord 49(1):59–72
Grawe K (1998) Psychologische Psychotherapie. Hogrefe, Göttingen
Hautzinger M (2003) Kognitive Verhaltenstherapie bei Depressionen. Behandlungsanleitungen und Materialien. Beltz, Weinheim
Hofmann SG, Sawyer AT, Witt AA, Oh D (2010) The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 78(2):169–183
Hohagen F, Stieglitz R, Bohus M et al (2009) Psychotherapie. In: Berger M (Hrsg) Psychische Erkrankungen. Klinik und Therapie. Elsevier, München
Hollon SD, Ponniah K (2010) A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety 27(10):891–932
Holtzheimer PE, Mayberg HS (2011) Stuck in a rut: rethinking depression and its treatment. Trends Neurosci 34(1):1–9
Keller MB, McCullough JP, Klein DN et al (2000) A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 342(20):1462–1470
Kocsis JH, Gelenberg AJ, Rothbaum BO et al (2009) Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry 66(11):1178–1188
Leichsenring F, Rabung S, Leibing E (2004) The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiatry 61(12):1208–1216
McCullough JP (2000) Treatment for chronic depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press, New York
Nemeroff CB, Heim CM, Thase ME et al (2003) Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A 100(24):14293–14296
Pilkonis PA, Frank E (1988) Personality pathology in recurrent depression: nature, prevalence, and relationship to treatment response. Am J Psychiatry 145:435–441
Schramm E, Calker D van, Dykierek P et al (2007) An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatients: acute and long-term results. Am J Psychiatry 164:768–777
Schramm E, Kech S, Zobel I et al (2009) Factors influencing the outcome of IPT in depressed patients: analysis of the mechanisms of change. Poster auf der 3rd International Conference of the International Society of IPT, march 2009, New York
Schramm E (2010) Interpersonelle Psychotherapie – zur Behandlung depressiver und anderer psychischer Störungen. 3. überarb. Aufl. Schattauer, Stuttgart
Schramm E, Zobel I, Dykierek P et al (2011) Cognitive behavioral analysis system of psychotherapy versus interpersonal psychotherapy for early-onset chronic depression: a randomized pilot study. J Affect Disord 129(1–3):109–116
Segal ZV, Williams JMG, Teasdale JD (2002) Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. Guilford Press, New York
Siegle GJ, Carter CS, Thase ME (2006) Use of fMRI to predict recovery from unipolar depression with cognitive behavior therapy. Am J Psychiatry 163:735–738
Thase ME, Dube S, Bowler K, Howland R (1996) Hypothalamic-pituitary-adrenocortical activity and response to cognitive behaviour therapy in unmedicated, hospitalized depressed patients. Am J Psychiatry 153(7):886–891
Thase ME, Buysse DJ, Frank E et al (1997) Which depressed patients will respond to Interpersonal Psychotherapy? The role of abnormal sleep EEG profiles. Am J Psychiatry 145:502–509
Tolin DF (2010) Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev 30(6):710–720
Wampold BE, Mondin GW, Moody M et al (1997) A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, „All Must Have Prizes“. Psychol Bull 122(3):203–215
Watson JC, Gordon LB, Stermac L et al (2003) Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. J Consult Clin Psychol 71(4):773–781
Programm für Nationale Versorgungsleitlinien der Bundesärztekammer, der Kassenärztlichen Bundesvereinigung und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften zur Qualitätsförderung in der Medizin (2009) www.versorgungsleitlinien.de
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Schramm, E., Berger, M. Differenzielle Indikation für Psychotherapie am Beispiel der Depression. Nervenarzt 82, 1414–1424 (2011). https://doi.org/10.1007/s00115-011-3350-3
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DOI: https://doi.org/10.1007/s00115-011-3350-3