Download PDF
Fortschr Neurol Psychiatr 2014; 82(3): 155-173
DOI: 10.1055/s-0034-1366027
Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Chronische Depression – Epidemiologische Daten und therapeutische Möglichkeiten

Chronic Depression – Epidemiological Data and Therapeutic Options
C. Schüle
  Psychiatrische Klinik der Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

Publication Date:
10 March 2014 (online)

    Permissions and Reprints

Lernziele

Dieser Fortbildungsartikel gibt einen Überblick über epidemiologische Daten zum Langzeitverlauf der unipolaren Depression und beleuchtet dabei den dynamischen Verlauf der unipolaren Depression mit Veränderungen des Schweregrads (Vollbild einer depressiven Episode, Dysthymie, subsyndromale depressive Symptome, asymptomatischer Zustand). Des Weiteren wird das Problem der Therapieresistenz und Chronifizierung dargestellt und die derzeit verfügbaren pharmakologischen, psychotherapeutischen und sonstigen Therapieoptionen bei chronisch depressiven Patienten werden kritisch diskutiert.

 

  • Literatur

  • 1 Wolfersdorf MH, Heindl A. Chronische Depression. Grundlagen, Erfahrungen und Empfehlungen. Lengerich: Pabst Science Publishers; 2003
    Google Scholar
  • 2 Laux G. Chronifizierte Depression. Stuttgart: Enke; 1986
    Google Scholar
  • 3 Klein DN. Chronic Depression: Diagnosis and Classification. Curr Dir Psychol Sci 2010; 19: 96-100
    CrossrefPubMedGoogle Scholar
  • 4 Kocsis JH. New strategies for treating chronic depression. J Clin Psychiatry 2000; 61 (Suppl. 11) S42-S45
    PubMedGoogle Scholar
  • 5 Marneros A, Deister A. Chronische Depression – Psychopathologie, Verlaufsaspekte und prädisponierende Faktoren. In: Möller HJ, , Hrsg. Therapieresistenz unter Antidepressiva-Behandlung. Heidelberg: Springer; 1990: 1-12
    CrossrefGoogle Scholar
  • 6 Jacobi F, Wittchen HU, Holting C et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004; 34: 597-611
    Google Scholar
  • 7 Undurraga J, Baldessarini RJ. Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology 2012; 37: 851-864
    CrossrefPubMedGoogle Scholar
  • 8 Souery D, Amsterdam J, de Montigny C et al. Treatment resistant depression: methodological overview and operational criteria. Eur Neuropsychopharmacol 1999; 9: 83-91
    CrossrefPubMedGoogle Scholar
  • 9 Thase ME, Rash JA. Treatment-resistant depression. In: Bloom FE KD, Hrsg Psychopharmacology. New York: Raven; 1995
    Google Scholar
  • 10 Thase ME. Evaluating antidepressant therapies: remission as the optimal outcome. J Clin Psychiatry 2003; 64 (Suppl. 13) S18-S25
    PubMedGoogle Scholar
  • 11 Han C, Yeh TL, Kato M et al. Management of chronic depressive patients with residual symptoms. CNS Drugs 2013; 27 (Suppl. 01) S53-S57
    CrossrefPubMedGoogle Scholar
  • 12 Thase ME. Update on partial response in depression. J Clin Psychiatry 2009; 70 (Suppl. 06) S4-S9
    PubMedGoogle Scholar
  • 13 Berndt ER, Koran LM, Finkelstein SN et al. Lost human capital from early-onset chronic depression. Am J Psychiatry 2000; 157: 940-947
    CrossrefPubMedGoogle Scholar
  • 14 Gilmer WS, Trivedi MH, Rush AJ et al. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand 2005; 112: 425-433
    CrossrefPubMedGoogle Scholar
  • 15 Rush AJ, Trivedi MH, Wisniewski SR et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006; 163: 1905-1917
    CrossrefPubMedGoogle Scholar
  • 16 Möller HJ, Riedel M, Seemüller F. Relapse or recurrence in depression: why has the cutoff been set at months?. Mediographa 2011; 33: 125-130
    PubMedGoogle Scholar
  • 17 Keller MB, Lavori PW, Mueller TI et al. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 1992; 49: 809-816
    CrossrefPubMedGoogle Scholar
  • 18 Mueller TI, Leon AC, Keller MB et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 1999; 156: 1000-1006
    PubMedGoogle Scholar
  • 19 Judd LL, Akiskal HS, Maser JD et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998; 55: 694-700
    CrossrefPubMedGoogle Scholar
  • 20 Judd LL. Dimensional paradigm of the long-term course of unipolar major depressive disorder. Depress Anxiety 2012; 29: 167-171
    CrossrefPubMedGoogle Scholar
  • 21 Judd LL, Akiskal HS, Maser JD et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 1998; 50: 97-108
    CrossrefPubMedGoogle Scholar
  • 22 Bschor T. Behandlungsmanual therapieresistente Depression. Stuttgart: Kohlhammer; 2008
    Google Scholar
  • 23 Bauer M, Berghöfer A, Adli M. Akute und therapieresistente Depression. Heidelberg: Springer; 2005
    CrossrefGoogle Scholar
  • 24 DGPPN, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg) für die Leitliniengruppe Unipolare Depression*. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression, Langfassung, Version 1.3 Januar 2012 basierend auf der Fassung von November 2009: DGPPN, ÄZQ, AWMF – Berlin. Düsseldorf: 2012
    PubMedGoogle Scholar
  • 25 Bauer M, Adli M, Bschor T et al. Lithium’s emerging role in the treatment of refractory major depressive episodes: augmentation of antidepressants. Neuropsychobiology 2010; 62: 36-42
    CrossrefPubMedGoogle Scholar
  • 26 Nierenberg AA. Predictors of response to antidepressants general principles and clinical implications. Psychiatr Clin North Am 2003; 26: 345-352
    CrossrefPubMedGoogle Scholar
  • 27 Folkerts HW. Elektrokrampftherapie. Indikation, Durchführung und Behandlungsergebnisse. Der Nervenarzt 2011; 82: 93-102
    CrossrefPubMedGoogle Scholar
  • 28 United Kingdom ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808
    CrossrefPubMedGoogle Scholar
  • 29 Plewnia C, Padberg F. Transkranielle und invasive Hirnstimulationsverfahren bei Depression. Der Nervenarzt 2012; 83: 1006-1012
    CrossrefPubMedGoogle Scholar
  • 30 Grimm S, Bajbouj M. Efficacy of vagus nerve stimulation in the treatment of depression. Expert Rev Neurother 2010; 10: 87-92
    CrossrefPubMedGoogle Scholar
  • 31 Coenen VA, Panksepp J, Hurwitz TA et al. Human medial forebrain bundle (MFB) and anterior thalamic radiation (ATR): imaging of two major subcortical pathways and the dynamic balance of opposite affects in understanding depression. J Neuropsychiatry Clin Neurosci 2012; 24: 223-236
    CrossrefPubMedGoogle Scholar
  • 32 Zarate Jr CA , Singh JB, Carlson PJ et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 2006; 63: 856-864
    CrossrefPubMedGoogle Scholar
  • 33 Diazgranados N, Ibrahim L, Brutsche NE et al. A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry 2010; 67: 793-802
    CrossrefPubMedGoogle Scholar
  • 34 Paul R, Schaaff N, Padberg F et al. Comparison of racemic ketamine and S-ketamine in treatment-resistant major depression: report of two cases. World J Biol Psychiatry 2009; 10: 241-244
    CrossrefPubMedGoogle Scholar
  • 35 Segmiller F, Frisse D, Eser D et al. Ketamin zur Behandlung der therapieresistenten Depression. Ein Fallbericht. Der Nervenarzt 2013; 84: 854-855
    CrossrefPubMedGoogle Scholar
  • 36 Segmiller F, Ruther T, Linhardt A et al. Repeated S-ketamine Infusions in Therapy Resistant Depression: A Case Series. J Clin Pharmacol 2013; 53: 996-998
    CrossrefPubMedGoogle Scholar
  • 37 de Lima MS, Hotoph M, Wessely S. The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis. Psychol Med 1999; 29: 1273-1289
    CrossrefPubMedGoogle Scholar
  • 38 American Psychiatric Association. Practice Guidelines for the Treatment of Patients with Major Depressive Disorder. third edition. Arlington (VA): Aufl; 2010
    Google Scholar
  • 39 National Institute for Health and Clinical Excellence (NICE). Depression: The Treatment and Management of Depression in Adults. National Clinical Practice Guidelines 90. London: 2009
    PubMedGoogle Scholar
  • 40 Kirsch I, Deacon BJ, Huedo-Medina TB et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5: e45
    CrossrefPubMedGoogle Scholar
  • 41 Möller HJ. Isn’t the efficacy of antidepressants clinically relevant? A critical comment on the results of the metaanalysis by Kirsch et al. Eur Arch Psychiatry Clin Neurosci 2008; 258: 451-455
    CrossrefPubMedGoogle Scholar
  • 42 Fournier JC, DeRubeis RJ, Hollon SD et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303: 47-53
    CrossrefPubMedGoogle Scholar
  • 43 Stewart JA, Deliyannides DA, Hellerstein DJ et al. Can people with nonsevere major depression benefit from antidepressant medication?. J Clin Psychiatry 2012; 73: 518-525
    CrossrefPubMedGoogle Scholar
  • 44 Gibbons RD, Hur K, Brown CH et al. Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012; 69: 572-579
    PubMedGoogle Scholar
  • 45 von Wolff A, Holzel LP, Westphal A et al. Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: a systematic review and meta-analysis. J Affect Disord 2013; 144: 7-15
    CrossrefPubMedGoogle Scholar
  • 46 Hegerl U, Schonknecht P, Mergl R. Are antidepressants useful in the treatment of minor depression: a critical update of the current literature. Curr Opin Psychiatry 2012; 25: 1-6
    CrossrefPubMedGoogle Scholar
  • 47 Brakemeier EL, Schramm E, Hautzinger M. Chronische Depression. Göttingen: Hogrefe; 2012
    Google Scholar
  • 48 Bohleber W. PSYCHE Sonderheft 2005: Depression – Psychoanalytische Erkundungen einer Zeitkrankheit. In Psyche 2005;
    PubMedGoogle Scholar
  • 49 Böker H, Nordhoff G, Hill J et al. Psyche 9/10 2010. Depression: Neue psychoanalytische Erkundungen einer Zeitkrankheit. In: Bohleber W, Hrsg Psyche. 2010
    Google Scholar
  • 50 Markowitz JC. Psychotherapy of dysthymia. Am J Psychiatry 1994; 151: 1114-1121
    PubMedGoogle Scholar
  • 51 Dunner DL, Schmaling KB, Hendrickson H et al. Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression 1996; 4: 34-41
    CrossrefPubMedGoogle Scholar
  • 52 Segal ZV, Whitney DK, Lam RW et al. Clinical guidelines for the treatment of depressive disorders. III. Psychotherapy. Can J Psychiatry 2001; 46 (Suppl. 01) S29-S37
    PubMedGoogle Scholar
  • 53 Browne G, Steiner M, Roberts J et al. Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. J Affect Disord 2002; 68: 317-330
    CrossrefPubMedGoogle Scholar
  • 54 Markowitz JC, Kocsis JH, Bleiberg KL et al. A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients. J Affect Disord 2005; 89: 167-175
    CrossrefPubMedGoogle Scholar
  • 55 Keller MB, McCullough JP, Klein DN et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 2000; 342: 1462-1470
    CrossrefPubMedGoogle Scholar
  • 56 Nemeroff CB, Heim CM, Thase ME et al. 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: 14293-14296
    CrossrefPubMedGoogle Scholar
  • 57 Kocsis JH, Gelenberg AJ, Rothbaum BO et al. Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry 2009; 66: 1178-1188
    CrossrefPubMedGoogle Scholar
  • 58 Cuijpers P, van Straten A, Schuurmans J et al. Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clin Psychol Rev 2010; 30: 51-62
    CrossrefPubMedGoogle Scholar
  • 59 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde DGPPN (Hrsg). S3 Praxisleitlinien in Psychiatrie und Psychotherapie. Band 1 – Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopff-Verlag; 2006
    Google Scholar
  • 60 Hegerl U. S3-Leitlinie „Unipolare Depression“: Ist eine aktiv-abwartende Begleitung bei leichten Depressionen vertretbar? Kommentar. Arzneimitteltherapie 2010; 28: 166-168
    PubMedGoogle Scholar
  • 61 Hegerl U, Hautzinger M, Mergl R et al. Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients’ choice arm. Int J Neuropsychopharmacol 2010; 13: 31-44
    CrossrefPubMedGoogle Scholar
  • 62 Möller HJ. Evidenzbasierung und leitliniengestützte Therapie in der Psychiatrie. In: Möller HJ, Laux G, Kapfhammer HP, , Hrsg. Psychiatrie, Psychosomatik, Psychotherapie Band 1: Allgemeine Psychiatrie. Heidelberg: Springer; 2011: 1177-1191
    CrossrefGoogle Scholar
  • 63 Kupfer DJ. Long-term treatment of depression. J Clin Psychiatry 1991; 52: S28-S34
    PubMedGoogle Scholar
  • 64 Berger M, von Calker D, Brakemeier EL et al. Affektive Erkrankungen. In: Berger M, Hrsg. Psychische Erkrankungen Klinik und Therapie. München: Urban & Fischer Verlag; 2011
    Google Scholar
  • 65 Hegerl U, Schonknecht P. Subdiagnostische Depressionen. Gibt es Behandlungen mit klinisch relevanten Effekten?. Der Nervenarzt 2009; 80: 532-534 , 536–539
    CrossrefPubMedGoogle Scholar
  • 66 Hautzinger M. Wirksamkeit und Wirkmechanismen von Psychotherapie bei Depressionen. Vorlesung Eberhard Karls Universität Tübingen, Psychologisches Institut 2007. http://www.uni-tuebingen.de/uni/sii/abtkpps/hautzing.htm
    Google Scholar