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PSYCH up2date 2020; 14(03): 239-252
DOI: 10.1055/a-0930-9995
Affektive Störungen

Chronische Depression – Klassifikation und therapeutische Maßnahmen

Franz-Josef Müller
,
Kamila Jauch-Chara
Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Prof. Dr. med. Kamila Jauch-Chara, Kiel.
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Depressionen gehören weltweit zu den häufigsten psychiatrischen Erkrankungen. Trotz der hohen Prävalenzrate und den anhaltenden Bemühungen, Erkenntnisse über die Ursachen, den Verlauf und die Therapie dieser Krankheit zu gewinnen, gilt die depressive Störung weiterhin als häufige, allerdings auch unterdiagnostizierte Krankheit (Übersicht bei [1]). Eine besondere Herausforderung ist hierbei die chronische Form der Erkrankung.
Kernaussagen

  • Etwa 20–30 % der Patienten mit einer depressiven Störung erfüllen die Kriterien einer chronischen Depression (Symptomatik, welche länger als 24 Monaten anhält).

  • Eine differenzierte Kodierung der depressiven Störung unter Berücksichtigung der therapierelevanten Parameter Erkrankungsdauer, Remissionsstärke und Chronizität ist im ICD-10 nicht möglich.

  • Bislang gibt es nur wenige Studien, welche die Wirksamkeit der Psycho- und Pharmakotherapie bei chronischer Depression untersuchen.

  • Sowohl Psycho- als auch Antidepressivatherapie sind der Placebobehandlung überlegen und sollten daher Patienten mit chronischer Depression angeboten werden.

  • Nach dem aktuellen Kenntnisstand ist eine Kombinationsbehandlung bestehend aus Psycho- und Pharmakotherapie wirksamer als alleinige Psycho- bzw. Pharmakotherapie.

  • Die aktuelle Studienlage spricht dafür, den Betroffenen CBASP als Behandlung der Wahl zu empfehlen.

  • Aufgrund der Studienlage sollte Patienten mit therapieresistenter Depression frühzeitig eine EKT-Behandlung empfohlen werden.



Publication History

Article published online:
04 May 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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