Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-24T18:38:17.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Tratamiento no farmacológico realizado por psiquiatras junto con la prescripción de un antidepresivo

Published online by Cambridge University Press:  12 May 2020

M. Linden ,
W. Dierkes  and
T. Munz
M. Linden
Affiliation:
Grupo de Investigación de Rehabilitación Psicosomática de Charité, Universidad de Medicina de Berlín, Alemania Centro de Rehabilitación Seehof, Teltow, Alemania
W. Dierkes
Affiliation:
Departamento Médico, Wyeth Pharma GmbH, Münster, Alemania
T. Munz
Affiliation:
Departamento Médico, Wyeth Pharma GmbH, Münster, Alemania
Get access

Resumen

Antecedentes.

Las guías para el tratamiento de la depresión insisten uniformemente en que la farmacoterapia de la depresión debería ir acompañada de psicoterapia de apoyo y otras intervenciones psicoterapéuticas. Desconocemos la atención que prestan los psiquiatras de atención primaria a dichas terapias verbales.

Métodos.

En un estudio sobre el uso del fármaco venlafaxina se pidió a psiquiatras de consultas privada y de hospitales que explicaran qué terapias no farmacológicas consideraban como parte importante del tratamiento del episodio depresivo presente. Además, se evaluaron las características de los pacientes, las variables del tratamiento y las del ámbito de atención y del psiquiatra.

Resultados.

Los psiquiatras administraban terapias verbales al 19% de los pacientes ambulatorios y al 36,8% de los hospitalizados. Las terapias verbales se administraban con más frecuencia a pacientes más jóvenes, que tenían más diagnósticos dobles y que estaban más graves. Los pacientes que recibían terapias verbales tomaban más medicación psicotrópica. En el ámbito hospitalario, las terapias verbales se relacionaron, generalmente con más tratamiento global y con una tasa mayor de respuesta al tratamiento. En ambos ámbitos de tratamiento, las terapias verbales se relacionaron con tasas menores de abandono del antidepresivo.

Conclusión.

Las interacciones verbales son parte de cualquier relación entre médico y paciente y deberían seguir guías teóricas como parte del proceso terapéutico de los trastornos depresivos. Teniendo esto en cuenta, la tasa de pacientes a los que los psiquiatras administraron alguna terapia verbal como parte explícita de su tratamiento podría ser mayor. Es necesaria más investigación sobre guías del paciente, consejo y psicoterapia de apoyo en psiquiatría.

Keywords

AntidepresivosDepresiónVenlafaxinaPsicoterapiaConsejoGuía del paciente
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 15 , Issue 1 , February 2008 , pp. 9 - 17
Copyright
Copyright © European Psychiatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

Agency for Health Care Policy and Research (AHCPR). Agency for Health Care Policy and Research (AHCPR)., Number 5. ln: Treatment of major depression, vol. 2. Rockville, MD: US Department of Health and Human Services, Public Health Services; 1993. AHCPR Pub. No. 93-0551.Google Scholar
American Psychiatric Association (APA). Practice guidelines for major depressive disorder (Revision). Am J Psychiatry 2000;157:1–49.Google Scholar
Ballenger, JC, Davidson, RT, Lecrubier, Y, Nutt, DJ, Goldberg, D, Magruder, KM, et al. Consensus statement on the primary care management of depression from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 1999;60:54–61.Google Scholar
Blackburn, I-M, Moore, RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy I out-patients with recurrent depression. Br J Psychiatry 1997;171:328–34.CrossRefGoogle ScholarPubMed
Bower, P, Byford, S, Barber, J, Beecham, J, Simpson, S, Friedls, K, et al. Meta-analysis of data on costs from triais of counseling in primary care: using individual patient data overcome sample size limitations in economic analyses. Br Med J 2003;326:1247–50.CrossRefGoogle Scholar
Colom, F, Lam, D. Psychoeducation: improving outcomes in bipolar disorder. Eur Psychiatry 2005;20:359–64.CrossRefGoogle ScholarPubMed
Crimson, ML, Trivedi, M, Pigott, TA, Rush, AJ, Hirschfeld, RMA, Kahn, DA, et al. the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. The Texas Medical Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. J Clin Psychiatry 1999;60:142–56.Google Scholar
DeMontigny, C, Silverstone, P, Debonnel, G, Blier, P, Bakish, D. Ven-lafaxine in treatment-resistant major depression: A Canadian multicenter, open-label trial. J Clin Psychopharmacology 1999;19:401–6.CrossRefGoogle Scholar
DÄ.Deutsches Ärzteblatt. Ergebnisse der Ärztestatistik. Dtsch Ärzteblatt 1999;26:3–11.Google Scholar
Entsuah, AR, Rudolph, RL, Chitra, R. Effectiveness of venlafaxine in a broad spectrum of depressed patients: a meta-analysis. Psychopharmacol Bull 1995;31:759–66.Google Scholar
Fawcett, J, Epstein, P, Fiester, SJ, Elkin, I, Autry, JH. Clinical management: imipramine/placebo administration manual. Psychopharmacol Bull 1987;23:309–23.Google ScholarPubMed
Frank, E. Interpersonal psychotherapy as a maintenance treatment for patients with recurrent depression. Psychotherapy 1991;28:259–66.CrossRefGoogle Scholar
Guy, W, Bonata, RR. 12-CG1, Clinical global impressions. In: Guy, W, Bonata, RR, editors. Manual for the ECDEU assessment battery. Chevy Chase MD: National Institute of Mental Health; 1976.Google Scholar
Hautzinger, M, De Jong-Meyer, R, Treiber, R, Rudolf, GAE, Thien, U.Wirksamkeit kognitiver Verhaltenstherapie, Pharmakotherapie und deren Kombination bei nicht-endogenen, unipolaren Depressionen. Z Klin Psychol 1996;25:130–45.Google Scholar
Hellerstein, D, Batchelder, S, Little, S, Fedak, M, Kreditor, D, Rosenthal, J. Venlafaxine in the treatment of dysthymia: an open-label study. J Clin Psychiatry 1999;60:845–9.CrossRefGoogle Scholar
Hollon, SD, DeRubeis, RJ, Evans, MD, Wiemer, MJ, Garvey, MJ, Grove, WM, et al. Cognitive therapy and pharmacotherapy for depression: singly and in combination. Arch Gen Psychiatry 1992;149:774–81.CrossRefGoogle Scholar
Hollon, SD, Najavits, L. Review of empirical studies on cognitive therapy. In: Frunces, JA, Sales, RE, editors. Ameritan Psychiatric Press review of psychiatry, val 7. Washingron, DC: Ameritan Psychiatric Press; 1988. p. 643-66.Google Scholar
Huibers, MJ, Beurskens, AJ, Bleijenberg, G, Van Schayck, CP. The effectiveness of psychosocial interventions delivered by general practitioners. Cochrane Database Syst Rev 2003. CD003494.CrossRefGoogle Scholar
De Jong-Meyer, R, Hautzinger, M, Rudolf, GAE, Strauβ, W, Frick, U. Die Uberprüfung der Wirksamkeit einer Kombimation von Antidepressivaund Verhaltenstherapie bei endogen depressiven Patienten: Varianzanalytische Ergebnisse zu den Haupt- und Nebenkriterien des Therapieerfolgs. Z Klin Psychol 1996;25:93–109.Google Scholar
Jorm, AF, Korten, AE, Jacomb, PA, Rodgers, B, Pollitt, P, Christensen, H, et al. Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public. Br J Psychiatry 1997;171:233–7.CrossRefGoogle ScholarPubMed
Jorm, AF, Korten, AE, Jacomb, PA, Rodgers, B, Pollitt, P. Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists. Aust N Z J Psychiatry 1997b;31:844–51.CrossRefGoogle Scholar
Judd, FK, Weissman, M, Davis, J, Hodgins, G, Piterman, L. Interpersonal counselling in general practice. Aust Fam Physician 2004;33:332–7.Google ScholarPubMed
Judd, FK, Piterman, L, Cockram, AM, McCall, L, Weissman, MM. A comparative study of venlafaxine with a focused education and psychotherapy program versus venlafaxine alone in the treatment of depression in general practice. Hum Psychopharmacol 2001;16:423–8.CrossRefGoogle ScholarPubMed
Kahn, A, Upton, V, Rudoplh, R, Entsual, R, Seventer, S. for the Venlafaxine Investigator Study Group. The use of venlafaxine in the treatment of major depression and major depression associated with anxiety: a dose-response study. J Clin Psychopharmacol 1998;18:19–25.CrossRefGoogle Scholar
Küchenhoff, J, Kern, C. Stationare Psychotherapie in der deutschsprachigem Schweiz. Schweiz Arch Neurol Psychiatrie 1998; 149: 11–20.Google Scholar
Langwieler, G, Linden, M. Therapist individuality in the diagnosis and treatment of depression. J Affect Disord 1993;27:1–12.CrossRefGoogle ScholarPubMed
Linden, M. Das pharmakotherapeutische Gespräch. Münchner Med Wochenschr 1986a; 128:513–5.Google Scholar
Linden, M. Therapeuten-Compliance. In: Helmchen, H, Hippius, H, editors. Psychiatrie für die Praxis. München: MMW Medizin Verlag; 1986b.Google Scholar
Linden, M, Ludewig, K, Munz, T. Depressive Erkrankungen und antidepressive Therapie. Ein Vergleich von Nervenarztpraxis und psychiatrischer Klinik. Der Nervenarzt 2001;72:521–8.CrossRefGoogle Scholar
Linden, M, Staats, M, Bär, T, Zubrägel, D. The assessment of treatment strategy in cognitive behavior therapy: using the pivotal topic measure. Psychother Res 2005;15:382–91.CrossRefGoogle Scholar
McCay, KM, Imel, ZF, Wampold, BE. Psychiatrist effects in the psychopharmacological treatment of depression. J Affect Disord 2006;92:287–90.CrossRefGoogle Scholar
Meredith, LS, Wells, KB, Kaplan, SH, Mazel, RM. Counseling typically provided for depression: role of clinician specialty and payment system. Arch Gen Psychiatry 1996;53:905–12.CrossRefGoogle ScholarPubMed
Michels, R. Psychotherapeutic approaches to the treatment of anxiety and depressive disorders. J Clin Psychiatry 1997;58:30–2.Google ScholarPubMed
Miller, P, Chilvers, C, Dewey, M, Fielding, K, Gretton, V, Palmer, B, et al. Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis. Int J Technol Assess Health Care 2003;19:80–90.CrossRefGoogle ScholarPubMed
Montgomery, SA, Åsberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–9.CrossRefGoogle ScholarPubMed
Mynors-Wallis, LM, Gath, DH, Lloyd-Thomas, AR, Tomlinson, D. Randomized controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ 1995;310:441–5.CrossRefGoogle ScholarPubMed
Peet, M, Harvey, NS. Lithium maintenance: a standard education programme for patients. Br J Psychiatry 1991;158:197–200.CrossRefGoogle ScholarPubMed
Pollock, K, Grime, J. GP's perspectives on managing time in consultations with patients suffering from depression: a qualitative study. Fam Pract 2003;20:262–9.CrossRefGoogle Scholar
Rush, AJ. Strategies and tactics in the management of maintenance treatment for depressed patients. J Clin Psychiatry 1999;60:21–6.Google ScholarPubMed
Schurman, RA, Mitchell, JB, Kramer, PD. When doctors listen: counseling patterns of nonpsychiatrist physicians. Am J Psychiatry 1985;142:934–8.Google ScholarPubMed
Simpson, S, Corney, R, Fitzgerald, P, Beecham, J. A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of psychodynamic counseling for general practice patients with chronic depression. Psychol Med 2003;33:191–6.CrossRefGoogle ScholarPubMed
Thase, ME, Friedman, ES, Berman, SR, Fasiezka, AL, Lis, JA, Howland, RH, et al. Is cognitive behavior therapy just a ‘nonspecific’ intervention for depression? A retrospective comparison of consecutive cohorts treated with cognitive behavior therapy or supportive counseling and pill placebo. J Affect Disord 2000;57:63–71.CrossRefGoogle ScholarPubMed
Van Os, TWDP, Van den Brink, RHS, Van der Meer, K, Ormel, J. The care provided by general practitioners for persistent depression. Eur Psychiatry 2006;21:87–92.CrossRefGoogle ScholarPubMed
Verkerk, GJ, Denollet, J, Van Heck, GL, Van Son, MJ, Pop, VJ. Patient preference for counselling predicts postpartum depression: a prospective 1 year follow up study in high-risk women. J Affect Disord 2004;83:43–8.CrossRefGoogle ScholarPubMed
WHO ICD-10. Geneva: World Health Organization; 1992.Google Scholar
Wilhelm, K, Wedgewood, L, Malhi, G, Mitchell, P, Austin, MP, Kotze, B, et al. Great expectations: factors influencing patient expectations and doctor recommendations at a mood disorder unit. J Affect Disord 2005;88:187–92.CrossRefGoogle Scholar