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DNP - Der Neurologe & Psychiater

, Volume 19, Issue 6, pp 24–30 | Cite as

Psychotherapie, Antidepressiva oder Kombinationsbehandlung?

Differenzielle Therapieentscheidung bei unipolaren Depressionen

  • Thomas Gärtner
  • Ulrich VoderholzerEmail author
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Depressionen können mit Psychotherapie, Pharmakotherapie oder mit einer Kombination beider Verfahren behandelt werden. Bei der Wahl der Therapiemethode sollten einerseits allgemeine Aspekte wie die Wirksamkeit und andererseits individuelle Patientenmerkmale wie Schweregrad, Alter, Persönlichkeit und Patientenpräferenz berücksichtigt werden.

Literatur

  1. 1.
    Jacobi F, Höfler M, Strehle J, Mack S, Gerschler A, Scholl L, Busch MA, Maske U, Hapke U, Gaebel W, Maier W, Wagner M, Zielasek J, Wittchen HU. Psychische Störungen in der Allgemeinbevölkerung Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH). Nervenarzt. 2014; 85 (1):77–87PubMedGoogle Scholar
  2. 2.
    Hollon SD, Thase ME, Markowitz JC. Treatment and Prevention of Depression. Psychol Sci Public Interest. 2002; 3 (2):39–77.PubMedGoogle Scholar
  3. 3.
    Eaton WW, Shao H, Nestadt G, Lee HB, Bienvenu OJ, Zandi P. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008; 65 (5):513–20PubMedPubMedCentralGoogle Scholar
  4. 4.
    Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. J Affect Disord. 2012; 139 (2):172–80PubMedPubMedCentralGoogle Scholar
  5. 5.
    Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018; 391 (10128):1357–1366PubMedPubMedCentralGoogle Scholar
  6. 6.
    DeRubeis RJ, Gelfand LA, Tang TZ, Simons AD. Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am J Psychiatry. 1999; 156 (7):1007–13PubMedGoogle Scholar
  7. 7.
    Spielmans GI, Berman MI, Usitalo AN. Psychotherapy versus second-generation antidepressants in the treatment of depression: a meta-analysis. J Nerv Ment Dis. 2011; 199 (3):142–9PubMedGoogle Scholar
  8. 8.
    Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. 2013; 12 (2):137–48PubMedPubMedCentralGoogle Scholar
  9. 9.
    Stassen HH, Angst J, Delini-Stula A. Delayed onset of action of antidepressant drugs? Survey of recent results. Eur Psychiatry. 1997; 12 (4):166–76PubMedGoogle Scholar
  10. 10.
    Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 2016; 10:1401–7PubMedPubMedCentralGoogle Scholar
  11. 11.
    Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012; 9 (5-6):41–6.PubMedPubMedCentralGoogle Scholar
  12. 12.
    ten Doesschate MC, Bockting CL, Schene AH. Adherence to continuation and maintenance antidepressant use in recurrent depression. J Affect Disord. 2009; 115 (1-2):167–70PubMedGoogle Scholar
  13. 13.
    Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom. 2015; 84 (2):72–81PubMedGoogle Scholar
  14. 14.
    Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review. Psychother Psychosom. 2018; 87 (4):195–203PubMedGoogle Scholar
  15. 15.
    Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression:maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000; 62 (5):633–8PubMedGoogle Scholar
  16. 16.
    Andrews PW, Thomson JA Jr, Amstadter A, Neale MC. Primum non nocere: an evolutionary nalysis of whether antidepressants do more harm than good. Front Psychol. 2012; 3:117PubMedPubMedCentralGoogle Scholar
  17. 17.
    Shrestha SS, Nelson EE, Liow JS, Gladding R, Lyoo CH, Noble PL, Morse C, Henter ID, Kruger J, Zhang B, Suomi SJ, Svenningsson P, Pike VW, Winslow JT, Leibenluft E, Pine DS, Innis RB. Fluoxetine administered to juvenile monkeys: effects on the serotonin transporter and behavior. Am J Psychiatry. 2014; 171 (3):323–31PubMedPubMedCentralGoogle Scholar
  18. 18.
    Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, Jüni P, Cuijpers P. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10 (5):e1001454PubMedPubMedCentralGoogle Scholar
  19. 19.
    Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther. 2018; 47 (1):1–18PubMedGoogle Scholar
  20. 20.
    Nieuwsma JA, Trivedi RB, McDuffie J, Kronish I, Benjamin D, Williams JW. Brief psychotherapy for depression: a systematic review and meta-analysis. Int J Psychiatry Med. 2012; 43 (2):129–51PubMedPubMedCentralGoogle Scholar
  21. 21.
    Cuijpers P, van Straten A, Warmerdam L. Are individual and group treatments equally effective in the treatment of depression in adults: a meta-analysis. European Journal of Psychiatry 2008; 22 (1): 38–51Google Scholar
  22. 22.
    Huntley AL, Araya R, Salisbury C. Group psychological therapies for depression in the community: systematic review and meta-analysis. Br J Psychiatry. 2012; 200 (3):184–90PubMedGoogle Scholar
  23. 23.
    Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, O’Mahen H, Watkins ER, Wright KA, Hollon SD, Reed N, Rhodes S, Fletcher E, Finning K. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, noninferiority trial. Lancet. 2016; 388 (10047):871–80PubMedPubMedCentralGoogle Scholar
  24. 24.
    Swift JK, Greenberg RP, Tompkins KA, Parkin SR. Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy (Chic). 2017; 54 (1):47–57Google Scholar
  25. 25.
    Thase ME, Greenhouse JB, Frank E, Reynolds CF 3rd, Pilkonis PA, Hurley K, Grochocinski V, Kupfer DJ. Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Arch Gen Psychiatry. 1997; 54 (11):1009–15PubMedGoogle Scholar
  26. 26.
    Weissman MM, Klerman GL, Prusoff BA, Sholomskas D, Padian N. Depressed outpatients. Results one year after treatment with drugs and/or interpersonal psychotherapy. Arch Gen Psychiatry. 1981; 38 (1):51–5PubMedGoogle Scholar
  27. 27.
    Kolovos S, Kleiboer A, Cuijpers P. Effect of psychotherapy for depression on quality of life: meta-analysis. Br J Psychiatry. 2016; 209 (6):460–468PubMedGoogle Scholar
  28. 28.
    Voderholzer U, Barton B. Langfristige Wirkung von Psychotherapie bei nichtchronischen Depressionen: Ein systematisches Review von Studien im Vergleich mit Pharmakotherapie. Verhaltenstherapie 201; 26:108–115Google Scholar
  29. 29.
    Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. 2013; 3(4)Google Scholar
  30. 30.
    Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord. 1998; 49 (1):59–72PubMedGoogle Scholar
  31. 31.
    Vittengl JR, Clark LA, Dunn TW, et al. Reducing Relapse and Recurrence in Unipolar Depression: a Comparative Meta-Analysis of Cognitive-Behavioral Therapy’s Effects. J Consult Clin Psychol 2007; 75 (3):475–88PubMedPubMedCentralGoogle Scholar
  32. 32.
    Linden M, Schermuly-Haupt ML. Definition, assessment and rate of psychotherapy side effects. World Psychiatry. 2014; 13 (3):306–9.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. 2004; 61 (7):714–9PubMedGoogle Scholar
  34. 34.
    Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a metaanalysis. World Psychiatry. 2014; 13 (1):56–67PubMedPubMedCentralGoogle Scholar
  35. 35.
    Friedman MA, Detweiler-Bedell JB, Leventhal HE. Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clin Psychol 2004; 11 (1):47–68Google Scholar
  36. 36.
    Karyotaki E, Smit Y, Holdt Henningsen K, Huibers MJ, Robays J, de Beurs D, Cuijpers P. Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects. J Affect Disord. 2016; 194:144–52PubMedGoogle Scholar
  37. 37.
    Cuijpers P, de Wit LM, Weitz ES, Andersson G., Huibers MJ. The combination ofpsychotherapy and pharmacotherapy in the treatment of adult depression: A comprehensive meta-analysis. Journal of Evidence-Based Psychotherapies. 2015; 15 (2):147–168Google Scholar
  38. 38.
    Hollon SD. The efficacy and acceptability of psychological interventions for depression: where we are now and where we are going. Epidemiol Psychiatr Sci. 2016; 25 (4):295–300PubMedGoogle Scholar
  39. 39.
    Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol. 1989; 57 (3):414–9.PubMedGoogle Scholar
  40. 40.
    Gaffan EA, Tsaousis I, Kemp-Wheeler SM. Researcher allegiance and meta-analysis: the case of cognitive therapy for depression. J Consult Clin Psychol. 1995; 63 (6):966–80PubMedGoogle Scholar
  41. 41.
    de Mello MF, de Jesus Mari J, Bacaltchuk J, Verdeli H, Neugebauer R. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci. 2005; 255 (2):75–82PubMedGoogle Scholar
  42. 42.
    Weitz ES, Hollon SD, Twisk J, van Straten A, Huibers MJ, David D, DeRubeis RJ, Dimidjian S, Dunlop BW, Cristea IA, Faramarzi M, Hegerl U, Jarrett RB, Kheirkhah F, Kennedy SH, Mergl R, Miranda J, Mohr DC, Rush AJ, Segal ZV, Siddique J, Simons AD, Vittengl JR, Cuijpers P. Baseline Depression Severity as Moderator of Depression Outcomes Between Cognitive Behavioral Therapy vs Pharmacotherapy: An Individual Patient Data Meta-analysis. JAMA Psychiatry. 2015; 72 (11):1102–9PubMedGoogle Scholar
  43. 43.
    Hollon SD, DeRubeis RJ, Fawcett J, Amsterdam JD, Shelton RC, Zajecka J, Young PR, Gallop R. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2014; 71 (10):1157–64PubMedPubMedCentralGoogle Scholar
  44. 44.
    Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry. 1989; 46 (11):971–82PubMedGoogle Scholar
  45. 45.
    Luty SE, Carter JD, McKenzie JM, Rae AM, Frampton CM, Mulder RT, Joyce PR. Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression. Br J Psychiatry. 2007; 190:496–502PubMedGoogle Scholar
  46. 46.
    Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL, Jacobson NS. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006; 74 (4):658–70PubMedGoogle Scholar
  47. 47.
    Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008; 76 (6):909–22PubMedGoogle Scholar
  48. 48.
    Imel ZE, Malterer MB, McKay KM, Wampold BE. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord. 2008; 110 (3):197–206PubMedGoogle Scholar
  49. 49.
    Cuijpers P, Reynolds CF 3rd, Donker T, Li J, Andersson G, Beekman A. Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depress Anxiety. 2012; 29 (10):855–64PubMedGoogle Scholar
  50. 50.
    Cuijpers P, van Straten A, Schuurmans J, van Oppen P, Hollon SD, Andersson G. Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clin Psychol Rev. 2010; 30 (1):51–62PubMedGoogle Scholar
  51. 51.
    von Wolff A, Hölzel LP, Westphal A, Härter M, Kriston L. Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: a systematic review and meta-analysis. BMC Psychiatry. 2012; 12:61PubMedPubMedCentralGoogle Scholar
  52. 52.
    Kriston L, von Wolff A, Westphal A, Hölzel LP, Härter M. Efficacy and acceptability of acute treatments for persistent depressive disorder: a network meta-analysis. Depress Anxiety. 2014; 31 (8):621–30PubMedGoogle Scholar
  53. 53.
    Nemeroff CB, Heim CM, Thase ME, Klein DN, Rush AJ, Schatzberg AF, Ninan PT, McCullough JP Jr, Weiss PM, Dunner DL, Rothbaum BO, Kornstein S, Keitner G, Keller MB. Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A. 2003; 100 (24):14293–6PubMedPubMedCentralGoogle Scholar
  54. 54.
    Zobel I, Kech S, van Calker D, Dykierek P, Berger M, Schneibel R, Schramm E. Longterm effect of combined interpersonal psychotherapy and pharmacotherapy in a randomized trial of depressed patients. Acta Psychiatr Scand. 2011; 123 (4):276–82PubMedGoogle Scholar
  55. 55.
    Reynolds CF 3rd, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA. 1999; 281 (1):39–45PubMedGoogle Scholar
  56. 56.
    Reynolds CF 3rd, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. N Engl J Med. 2006; 354 (11):1130–8PubMedGoogle Scholar
  57. 57.
    Lenze EJ, Dew MA, Mazumdar S, Begley AE, Cornes C, Miller MD, Imber SD, Frank E, Kupfer DJ, Reynolds CF 3rd. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment. Am J Psychiatry. 2002; 159 (3):466–8PubMedGoogle Scholar
  58. 58.
    Kiosses DN, Leon AC, Areán PA. Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am. 2011; 34 (2):377–401PubMedPubMedCentralGoogle Scholar
  59. 59.
    Fournier JC, DeRubeis RJ, Shelton RC, Gallop R, Amsterdam JD, Hollon SD. Antidepressant medications v. cognitive therapy in people with depression with or without personality disorder. Br J Psychiatry. 2008; 192 (2):124–9PubMedPubMedCentralGoogle Scholar
  60. 60.
    Bagby RM, Psych C, Quilty LC, Ryder AC. Personality and depression. Can J Psychiatry. 2008; 53 (1):14–25PubMedGoogle Scholar
  61. 61.
    Bellino S, Zizza M, Rinaldi C, Bogetto F. Combined treatment of major depression in patients with borderline personality disorder: a comparison with pharmacotherapy. Can J Psychiatry. 2006; 51 (7):453–60PubMedGoogle Scholar
  62. 62.
    Kool S, Dekker J, Duijsens IJ, de Jonghe F, Puite B. Efficacy of combined therapy and pharmacotherapy for depressed patients with or without personality disorders. Harv Rev Psychiatry. 2003; 11 (3):133–41PubMedGoogle Scholar
  63. 63.
    Carter JD, Luty SE, McKenzie JM, Mulder RT, Frampton CM, Joyce PR. Patient predictors of response to cognitive behaviour therapy and interpersonal psychotherapy in a randomised clinical trial for depression. J Affect Disord. 2011; 128 (3):252–61PubMedGoogle Scholar
  64. 64.
    Joyce PR, McKenzie JM, Carter JD, Rae AM, Luty SE, Frampton CM, Mulder RT. Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive-behavioural therapy for depression. Br J Psychiatry. 2007; 190:503–8PubMedGoogle Scholar
  65. 65.
    McBride C, Atkinson L, Quilty LC, Bagby RM. Attachment as moderator of treatment outcome in major depression: a randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. Journal of Consulting and Clinical Psychology. 2006; 74:1041–54PubMedGoogle Scholar
  66. 66.
    Barber JP, Muenz LR. The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program. Journal of Consulting and Clinical Psychology. 1996; 64:951–8PubMedGoogle Scholar
  67. 67.
    McHugh RK, Whitton SW, Peckham AD, Welge JA, Otto MW. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry. 2013; 74 (6):595–602PubMedPubMedCentralGoogle Scholar
  68. 68.
    Kocsis JH, Leon AC, Markowitz JC, Manber R, Arnow B, Klein DN, Thase ME. Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. J Clin Psychiatry. 2009; 70 (3):354–61PubMedGoogle Scholar
  69. 69.
    Winter SE, Barber JP. Should treatment for depression be based more on patient preference? Patient Prefer Adherence. 2013; 7:1047–57PubMedPubMedCentralGoogle Scholar
  70. 70.
    Raue PJ, Schulberg HC, Heo M, Klimstra S, Bruce ML. Patients’ depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study. Psychiatr Serv. 2009; 60 (3):337–43PubMedPubMedCentralGoogle Scholar
  71. 71.
    DeRubeis RJ, Cohen ZD, Forand NR, Fournier JC, Gelfand LA, Lorenzo-Luaces L. The Personalized Advantage Index: translating research on prediction into individualized treatment recommendations. A demonstration. PLoS One. 2014; 9 (1):e83875PubMedPubMedCentralGoogle Scholar
  72. 72.
    Huibers MJ, Cohen ZD, Lemmens LH, Arntz A, Peeters FP, Cuijpers P, & DeRubeis RJ. Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach. PloS one. 2015; 10(11), e0140771PubMedPubMedCentralGoogle Scholar
  73. 73.
    Bschor T, Baethge C, Hiemke C, Müller-Oerlinghausen B. Genetische Tests zur Steuerung der Behandlung mit Antidepressiva. Nervenarzt. 2017; 88 (5):495–499PubMedGoogle Scholar
  74. 74.
    Dunlop BW, Rajendra JK, Craighead WE, Kelley ME, McGrath CL, Choi KS, Kinkead B, Nemeroff CB, Mayberg HS. Functional Connectivity of the Subcallosal Cingulate Cortex And Differential Outcomes to Treatment With Cognitive-Behavioral Therapy or Antidepressant Medication for Major Depressive Disorder. Am J Psychiatry. 2017; 174 (6):533–545PubMedPubMedCentralGoogle Scholar

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© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Schön Klinik Bad ArolsenBad ArolsenDeutschland
  2. 2.Schön Klinik RoseneckPrien am ChiemseeDeutschland

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