Psychotherapie der chronischen Depression

Zusammenfassung

Chronische Verläufe depressiver Störungen werden diagnostisch in ICD-10 nicht ausreichend abgebildet. Zu der im neuen DSM-5 verankerten Krankheitsentität der “persistierenden depressiven Störung” gibt es kein Korrelat. Gleichwohl ist der Langzeitverlauf depressiver Störungen von hoher klinischer Relevanz. Chronizität ist mit Therapieresistenz und vermehrter Suizidalität assoziiert, ist durch erhebliche psychosoziale Einschränkungen gekennzeichnet und mit z. B. einer höheren Komorbidität mit Angstsyndromen, somatoformen Beschwerden und Persönlichkeitsstörungen vergesellschaftet. In vielen Leitlinien wird dabei ein kombiniertes Vorgehen aus Pharmakotherapie, anderen neurobiologischen Therapieansätzen und Psychotherapie empfohlen. Diese Übersichtsarbeit stellt die wesentlichen psychotherapeutischen Ansätze für die Behandlung chronischer Depressionen zusammen und bewertet die Studienlage. Aufgrund der aktuellen Datenlage ergibt sich hierbei ein Fokus auf das Cognitive Behavioral Analysis System of Psychotherapy (CBASP), das gegenwärtig in vielen Kliniken sowie in ambulanten und teilstationären Settings erprobt wird. Zudem wird ein Ausblick auf notwendige Entwicklungen und Forschungsbedarf im Bereich chronischer Depressionen gegeben.

Summary

Current diagnostic ICD-10 tools do not reflect chronic courses in depressive disorders as there is no equivalent for the new DSM-5 category of persistent depressive disorder. However, the long-term course of depressive disorders is of major clinical importance. Chronicity is often associated with therapy resistance and increased suicidality, significant impairment of psychosocial functioning and comorbidity with anxiety disorders, somatoform disorders and personality disorders. Guidelines in this field often recommend combined treatment with pharmacotherapy, other somatic treatments and psychotherapy. This review gives an overview of psychotherapeutic approaches investigated in chronic depression and reports the relevant evidence of efficacy/effectiveness. Based on the available data there is a focus on Cognitive Behavioral Analysis System of Psychotherapy (CBASP) which is currently introduced in many inpatient, day clinic and outpatient settings. Moreover, the review provides a perspective for future development and research needed.

Schlüsselwörter

CBASP - psychodynamische Psychotherapie - chronische Depression - persistierende depressive Störung

Keywords

CBASP - psychodynamic psychotherapy - chronic depression - persistent depressive disorder

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