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Chronic depression: special psychotherapy for seriously ill patients


Chronic depression is more treatable with specific psychotherapy
Almost ten percent of people worldwide suffer from depression and anxiety. In some cases, the treatment of the mental illness is particularly difficult. A study has now shown that chronic depression is more treatable with specific psychotherapy.

Every tenth person suffers from depression
Almost every tenth person in the world suffers from depression or anxiety. According to experts, over six million people are affected in Germany alone within one year. Mental illness is traditionally treated with medication (antidepressants) and psychotherapy. Studies have now shown that specific psychotherapy for the treatment of chronic depression, which takes stressful relationship experiences into account, is superior to non-specific supportive psychotherapy.

Chronic depression is considered difficult to treat
Scientists from the Freiburg University Hospital found this out in collaboration with the University Hospital Hamburg-Eppendorf (UKE) and six other German universities.

The results of the study have now been published in the specialist journal "JAMA Psychiatry".

As stated in a communication from the Freiburg University Hospital, chronic depression is considered difficult to treat. Accordingly, the majority of patients do not respond to multiple psychotherapeutic and drug therapy attempts.

"Therefore, chronic depression leads to a considerable burden of illness, which is characterized above all by a long-term impairment of performance and quality of life," explained Prof. Dr. Elisabeth Schramm from Freiburg University Hospital, who carried out the investigation together with Prof. Martin Härter, PD Dr. Levente Kriston and Ramona Meister performed from UKE side.

Developed specific and structured psychotherapy
According to the communication, a specific and structured psychotherapy for the treatment of chronic depression has been developed for the first time in recent years, the "Cognitive Behavioral Analysis System of Psychotherapy" (CBASP).

In this treatment developed in the USA, therapists focus intensely on stressful relationship experiences, which many chronically depressed patients report.

"During therapy, patients learn to recognize the connection between current problems and previous hurtful experiences and to make their interpersonal relationships more successful in everyday life," explained UKE professor Härter.

Improved performance and quality of life
In the current study, the scientists compared the effectiveness of CBASP with supportive psychotherapy, so-called supportive therapy.

In order to achieve their results, they treated a total of 268 patients with early-onset chronic depression at eight university centers (Lübeck, Hamburg, Heidelberg, Tübingen, Bonn, Marburg, Mannheim, Freiburg).

The patients were randomly assigned to receive one of the two treatments. The individual outpatient therapy lasted one year, comprised 32 sessions and was carried out without accompanying medication.

According to the researchers, both treatments led to a significant improvement for the patients, which was shown both in the reduction of depressive symptoms and in an improved overall performance and quality of life.

However, more patients responded to specific therapy with CBASP at the end of treatment. A complete improvement in depressive symptoms was also achieved significantly more frequently with CBASP.

Treatment success could be increased
According to the scientists, this is a remarkable success given the severity and persistence of the disease.

"In our view, the most important result of this study is that even difficult-to-treat chronically depressed patients can be helped with disorder-specific psychotherapy alone if this psychotherapy is offered over a longer period of time," says Prof. Schramm.

The study was the first to test the effectiveness of the newly developed method compared to non-specific psychotherapy.

"Possibly the success of treatment can be increased in the future by a combination of psychotherapy and antidepressant medication, this would have to be examined in subsequent studies", added Prof. Härter. (ad)

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