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Nervenheilkunde 2011; 30(11): 902-907
DOI: 10.1055/s-0038-1628444
Depression
Schattauer GmbH

Psychopharmako- und Psychotherapie bei Patienten mit minorer Depression

Sind die Effekte klinisch bedeutsam?Effects of pharmaco- and psychotherapy in minor depressive disordersIs there a clinical significance?
R. Mergl
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig
,
P. Schönknecht
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig
,
A.-K. Allgaier
2   Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Ludwig-Maximilians-Universität München
,
V. Henkel
3   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
,
U. Hegerl
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig
› Author Affiliations
Further Information

Publication History

eingegangen am: 05 April 2011

angenommen am: 16 June 2011

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Patienten mit depressiven Syndromen bei starker Beeinträchtigung des psychosozialen Funktionsniveaus, die aber die nach ICD-10 oder DSM-IV-TR erforderlichen Kriterien einer depressiven Störung nur teilweise erfüllen, sind in nervenärztlichen Praxen häufig anzutreffen. Im Folgenden werden wichtige therapeutische Ansätze bei derartigen minoren Depressionen präsentiert und deren klinische Signifikanz diskutiert. Da die Evidenzbasis für eine spezifische Pharmakooder Psychotherapie unzureichend ist, kommen aktives Monitoring oder unspezifische Beratungsund Betreuungsangebote in Betracht. Spezifische Behandlungsangebote (Antidepressiva, Psychotherapie) müssen in Erwägung gezogen werden bei Suizidalität, Suizidversuchen in der Anamnese, hohem Leidensdruck, früheren depressiven Episoden, Residualsymptomatik nach majorer Depression oder positiver Familienanamnese für affektive Störungen.

Summary

In psychiatric practices, depressive syndromes going along with considerable impairment of psychosocial functioning and only partly fulfilling the diagnostic criteria of a depressive disorder according to ICD-10 or DSM-IV-TR are frequent phenomena. In this paper, relevant therapeutic aspects of minor depression will be presented and their clinical significance will be discussed. In view of the insufficient evidence base for a specific drug therapy or psychotherapy in patients with minor depression watchful waiting, unspecific counselling and support can be considered. Specific treatment like antidepressant drugs or psychotherapy must be taken into consideration in the case of the following factors: suicidality, previous suicide attempts, high psychological strain, previous depressive episodes or residual symptoms after an episode of major depression as well as family history of affective disorders.

Schlüsselwörter

Antidepressiva - klinische Studie - minore Depression - Placebo-Verum-Differenz

Keywords

Antidepressants - clinical trial - minor depression - placebo-verum difference
 

  • Literatur

  • 1 Angst J, Merikangas K. The depressive spectrum: diagnostic classification and course. Journal of Affective Disorders 1997; 45: 31-39.
    CrossrefPubMedGoogle Scholar
  • 2 APA. Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. American Journal of Psychiatry 2000; 157: 1-45.
    PubMedGoogle Scholar
  • 3 Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. British Journal of Psychiatry 2011; 198: 11-16.
    CrossrefPubMedGoogle Scholar
  • 4 Barrett JE, Williams Jr JW, Oxman TE, Frank E, Katon W, Sullivan M, Hegel MT, Cornell JE, Sengupta AS. Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. Journal of Family Practice 2001; 50: 405-412.
    Google Scholar
  • 5 Bauer M, Bschor T, Pfennig A, Whybrow PC, Angst J, Versiani M, Möller H-J. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders in primary care. World Journal of Biological Psychiatry 2007; 08: 67-104.
    Google Scholar
  • 6 Blazer DG, Kessler RC, Swartz MS. Epidemiology of recurrent major and minor depression with a seasonal pattern. The National Comorbidity Survey. British Journal of Psychiatry 1998; 172: 164-167.
    CrossrefPubMedGoogle Scholar
  • 7 Blier P, Keller MB, Pollack MH, Thase ME, Zajecka JM, Dunner DL. Preventing recurrent depression: long-term treatment for major depressive disorder. Journal of Clinical Psychiatry 2007; 68: e06.
    PubMedGoogle Scholar
  • 8 Burrows AB, Salzman C, Satlin A, Noble K, Pollock BG, Gersh T. A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression. Depression and Anxiety 2002; 15: 102-110.
    CrossrefPubMedGoogle Scholar
  • 9 Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. Journal of Affective Disorders 2002; 72: 227-236.
    CrossrefPubMedGoogle Scholar
  • 10 Cuijpers P, Smit F. Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavica 2004; 109: 325-331.
    CrossrefPubMedGoogle Scholar
  • 11 Cuijpers P, Smit F, Oostenbrink J, de Graaf R, Ten Have M, Beekman A. Economic costs of minor depression: a population-based study. Acta Psychiatrica Scandinavica 2007; 115: 229-236.
    CrossrefPubMedGoogle Scholar
  • 12 Cuijpers P, Smit F, van Straten A. Psychological treatments of subthreshold depression: a meta-analytic review. Acta Psychiatrica Scandinavica 2007; 115: 434-441.
    CrossrefPubMedGoogle Scholar
  • 13 Davidson JR. Major depressive disorder treatment guidelines in America and Europe. Journal of Clinical Psychiatry 2010; 71 (Suppl.E1) e04.
    PubMedGoogle Scholar
  • 14 Davidson JR, Giller EL, Zisook S, Overall JE. An efficacy study of isocarboxazid and placebo in depression, and its relationship to depressive nosology. Archives of General Psychiatry 1988; 45: 120-127.
    CrossrefPubMedGoogle Scholar
  • 15 Demyttenaere K, Adelin A, Patrick M, Walthère D, Katrien Bde, Michele S. Six-month compliance with antidepressant medication in the treatment of major depressive disorder. International Clinical Psychopharmacology 2008; 23: 36-42.
    CrossrefPubMedGoogle Scholar
  • 16 DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung. Berlin und Düsseldorf: DGPPN, ÄZQ, AWMF; 2009
    Google Scholar
  • 17 Dilling H, Mombour W, Schmidt MH, SchulteMarkwort E. (Hrsg.) Internationale Klassifikation psychischer Störungen. ICD-10, Kapitel V(F). Forschungskriterien. Bern: Huber; 1994
    Google Scholar
  • 18 Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 2005; 62: 66-72.
    CrossrefPubMedGoogle Scholar
  • 19 Frank E, Rucci P, Katon W, Barrett J, Williams Jr JW, Oxman T, Sullivan M, Cornell J. Correlates of remission in primary care patients treated for minor depression. General Hospital Psychiatry 2002; 24: 12-19.
    CrossrefPubMedGoogle Scholar
  • 20 Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 2003; 361: 653-661.
    CrossrefPubMedGoogle Scholar
  • 21 Geddes J, Freemantle N, Mason J, Eccles M, Boynton J. Selective serotonin reuptake inhibitors (SSRIs) versus other antidepressants for depression. Cochrane Database Systematic Reviews. 2006 03. CD001851..
    Google Scholar
  • 22 Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 1960; 23: 56-62.
    CrossrefPubMedGoogle Scholar
  • 23 Hegerl U, Hautzinger M, Mergl R, Kohnen R, Schütze M, Scheunemann W, Allgaier A-K, Coyne J, Henkel V. Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients’ choice arm. International Journal of Neuropsychopharmacology 2010; 13: 31-44.
    CrossrefPubMedGoogle Scholar
  • 24 Hegerl U, Mergl R. The clinical significance of antidepressant treatment effects cannot be derived from placebo-verum response differences. Editorial. Journal of Psychopharmacology 2010; 24: 445-448.
    Google Scholar
  • 25 Hegerl U, Plattner A, Möller H-J. Should combined pharmacoand psychotherapy be offered to depressed patients? A qualitative review of randomized clinical trials from the 1990s. European Archives of Psychiatry and Clinical Neuroscience 2004; 254: 99-107.
    CrossrefPubMedGoogle Scholar
  • 26 Hegerl U, Schönknecht P. Subdiagnostische Depressionen – Gibt es Behandlungen mit klinisch relevanten Effekten?. Nervenarzt 2009; 80: 532-539.
    CrossrefPubMedGoogle Scholar
  • 27 Henkel V, Seemüller F, Obermeier M, Adli M, Bauer M, Mundt C, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Mayr A, Möller H-J, Riedel M. Does early improvement triggered by antidepressants predict response/remission? Analysis of data from a naturalistic study on a large sample of inpatients with major depression. Journal of Affective Disorders 2009; 115: 439-449.
    CrossrefPubMedGoogle Scholar
  • 28 Hollyman JA, Freeling P, Paykel ES, Bhat A, Sedgwick P. Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice. Journal of the Royal College of General Practice 1988; 38: 393-397.
    Google Scholar
  • 29 Judd LL, Rapaport MH, Paulus MP, Brown JL. Subsyndromal symptomatic depression: a new mood disorder?. Journal of Clinical Psychiatry 1994; 55 (Suppl.) 18-28.
    PubMedGoogle Scholar
  • 30 Judd LL, Rapaport MH, Yonkers KA, Rush AJ, Frank E, Thase ME, Kupfer DJ, Plewes JM, Schettler PJ, Tollefson G. Randomized, placebo-controlled trial of fluoxetine for acute treatment of minor depressive disorder. American Journal of Psychiatry 2004; 161: 1864-1871.
    CrossrefPubMedGoogle Scholar
  • 31 Kessler RC, Zhao S, Blazer DG, Swartz M. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. Journal of Affective Disorders 1997; 45: 19-30.
    CrossrefPubMedGoogle Scholar
  • 32 Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine 2008; 05: e45.
    CrossrefPubMedGoogle Scholar
  • 33 Kornstein SG. 2008. Maintenance therapy to prevent recurrence of depression: summary and implications of the PREVENT study. Expert Review of Neurotherapeutics 2008; 08: 737-742.
    Google Scholar
  • 34 Mergl R, Henkel V, Allgaier A-K, Kramer D, Hautzinger M, Kohnen R, Coyne JC, Hegerl U. Are treatment preferences relevant for response to serotonergic antidepressants and cognitive-behavioural therapy in depressed primary care patients? Results from a randomized controlled trial including a patients’ choice arm. Psychotherapy and Psychosomatics 2011; 80: 39-47.
    CrossrefPubMedGoogle Scholar
  • 35 Middleton H, Shaw I, Hull S, Feder G. NICE guidelines for the management of depression. British Medical Journal 2005; 330: 267-268.
    CrossrefPubMedGoogle Scholar
  • 36 NICE. Depression: management of depression in primary and secondary care. Clinical practice guideline No 23. London: National Institute for Clinical Excellence; 2004
    Google Scholar
  • 37 NICE. Depression: the treatment and management of depression in adults. National Clinical Practice Guideline 90. London: National Institute for Health and Clinical Excellence; 2009
    Google Scholar
  • 38 Nutt DJ, Sharpe M. Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. Journal of Psychopharmacology 2008; 22: 3-6.
    PubMedGoogle Scholar
  • 39 Oxman TE, Barrett JE, Sengupta A, Katon W, Williams Jr JW, Frank E, Hegel M. Status of minor depression or dysthymia in primary care following a randomized controlled treatment. General Hospital Psychiatry 2001; 23: 301-310.
    CrossrefPubMedGoogle Scholar
  • 40 Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Patient adherence in the treatment of depression. British Journal of Psychiatry 2002; 180: 104-109.
    CrossrefPubMedGoogle Scholar
  • 41 Papakostas GI, Perlis RH, Scalia MJ, Petersen TJ, Fava M. A meta-analysis of early sustained response rates between antidepressants and placebo for the treatment of major depressive disorder. Journal of Clinical Psychopharmacology 2006; 26: 56-60.
    CrossrefPubMedGoogle Scholar
  • 42 Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A place-bo controlled trial. Pharmacopsychiatry 1988; 21: 15-18.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Paykel ES, Hollyman JA, Freeling P, Sedgwick P. Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. Journal of Affective Disorders 1988; 14: 83-95.
    CrossrefPubMedGoogle Scholar
  • 44 Penninx BW, Geerlings SW, Deeg DJ, van Eijk JT, van Tilburg W, Beekman AT. Minor and major depression and the risk of death in older persons. Archives of General Psychiatry 1999; 56: 889-895.
    CrossrefPubMedGoogle Scholar
  • 45 Pincus HA, Davis WW, McQueen LE. Subthreshold mental disorders. A review and synthesis of studies on minor depression and other brand names. British Journal of Psychiatry 1999; 174: 288-296.
    CrossrefPubMedGoogle Scholar
  • 46 Preisig M, Merikangas KR, Angst J. Clinical significance and comorbidity of subthreshold depression and anxiety in the community. Acta Psychiatrica Scandinavica 2001; 104: 96-103.
    CrossrefPubMedGoogle Scholar
  • 47 Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. Journal of Affective Disorders 1998; 48: 227-232.
    CrossrefPubMedGoogle Scholar
  • 48 Reynolds 3rd CF, 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. New England Journal of Medicine 2006; 354: 1130-1138.
    CrossrefPubMedGoogle Scholar
  • 49 Robinson LA, Berman JS, Neimeyer RA. Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychological Bulletin 1990; 108: 30-49.
    CrossrefPubMedGoogle Scholar
  • 50 Rucci P, Gherardi S, Tansella M, Piccinelli M, Berardi D, Bisoffi G, Corsino MA, Pini S. Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. Journal of Affective Disorders 2003; 76: 171-181.
    CrossrefPubMedGoogle Scholar
  • 51 Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns C. The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Research 1986; 18: 65-87.
    CrossrefPubMedGoogle Scholar
  • 52 Saß H, Wittchen H-U, Zaudig M, Houben I. Diagnostische Kriterien DSM-IV-TR. Göttingen: Hogrefe; 2003
    Google Scholar
  • 53 Schulberg HC, Raue PJ, Rollman BL. The effectiveness of psychotherapy in treating depressive disorders in primary care practice: clinical and cost perspectives. General Hospital Psychiatry 2002; 24: 203-212.
    CrossrefPubMedGoogle Scholar
  • 54 Sneed JR, Rutherford BR, Rindskopf D, Lane DT, Sackeim HA, Roose SP. Design makes a difference: a meta-analysis of antidepressant response rates in placebo-controlled versus comparator trials in latelife depression. American Journal of Geriatric Psychiatry 2008; 16: 65-73.
    CrossrefPubMedGoogle Scholar
  • 55 Stassen HH, Angst J, Hell D, Scharfetter C, Szegedi A. Is there a common resilience mechanism underlying antidepressant drug response? Evidence from 2848 patients. Journal of Clinical Psychiatry 2007; 68: 1195-1205.
    CrossrefPubMedGoogle Scholar
  • 56 Sullivan MD, Katon WJ, Russo JE, Frank E, Barrett JE, Oxman TE, Williams Jr JW. Patient beliefs predict response to paroxetine among primary care patients with dysthymia and minor depression. Journal of the American Board of Family Practice 2003; 16: 22-31.
    CrossrefPubMedGoogle Scholar
  • 57 Szegedi A, Müller MJ, Anghelescu I, Klawe C, Kohnen R, Benkert O. Early improvement under mirtazapine and paroxetine predicts later stable response and remission with high sensitivity in patients with major depression. Journal of Clinical Psychiatry 2003; 64: 413-420.
    CrossrefPubMedGoogle Scholar
  • 58 Tadiç A, Helmreich I, Mergl R, Hautzinger M, Kohnen R, Henkel V, Hegerl U. Early improvement is a predictor of treatment outcome in patients with mild major, minor or subsyndromal depression. Journal of Affective Disorders 2010; 120: 86-93.
    CrossrefPubMedGoogle Scholar
  • 59 Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and metaanalysis. Archives of General Psychiatry 2006; 63: 1217-1223.
    CrossrefPubMedGoogle Scholar
  • 60 van Calker D, Zobel I, Dykierek P, Deimel CM, Kech S, Lieb K, Berger M, Schramm E. Time course of response to antidepressants: predictive value of early improvement and effect of additional psychotherapy. Journal of Affective Disorders 2009; 114: 243-253.
    CrossrefPubMedGoogle Scholar
  • 61 Veerman JL, Dowrick C, Ayuso-Mateos JL, Dunn G, Barendregt JJ. Population prevalence of depression and mean Beck Depression Inventory score. British Journal of Psychiatry 2009; 195: 516-519.
    CrossrefPubMedGoogle Scholar
  • 62 Ware J, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. Journal of Clinical Epidemiology 1998; 51: 903-912.
    CrossrefPubMedGoogle Scholar
  • 63 Williams Jr JW, Barrett J, Oxman T, Frank E, Katon W, Sullivan M, Cornell J, Sengupta A. Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. Journal of the American Medical Association 2000; 284: 1519-1526.
    CrossrefPubMedGoogle Scholar
  • 64 Wittchen H-U, Essau CA. Comorbidity and mixed anxiety-depressive disorders: is there epidemiologic evidence?. Journal of Clinical Psychiatry. 1993. 54 (Suppl.) 9-15.
    Google Scholar
  • 65 Wittchen H-U, Pfister H. Instruktionsmanual zur Durchführung von DIA-X Interviews. Frankfurt am Main: Swets Test Services; 1997
    Google Scholar
  • 66 World Health Organization. Composite International Diagnostic Interview, Version 1.1. Genf: World Health Organization; 1993
    Google Scholar