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European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

Part of: EPA Guidance Papers

Published online by Cambridge University Press:  23 March 2020

A. Jobst ,
E.-L. Brakemeier ,
A. Buchheim ,
F. Caspar ,
P. Cuijpers ,
K.P. Ebmeier ,
P. Falkai ,
Gaag R. Jan van der ,
W. Gaebel  and
S. Herpertz
...Show all authors
A. Jobst
Affiliation:
Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
E.-L. Brakemeier
Affiliation:
Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany
A. Buchheim
Affiliation:
Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
F. Caspar
Affiliation:
Institute of Psychology, University of Bern, Bern, Switzerland
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
K.P. Ebmeier
Affiliation:
Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom
P. Falkai
Affiliation:
Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
Gaag R. Jan van der
Affiliation:
University Medical Centre, St. Radboud, Nijmegen, The Netherlands
W. Gaebel
Affiliation:
Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
S. Herpertz
Affiliation:
Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany
T. Kurimay
Affiliation:
Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
L. Sabaß
Affiliation:
Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
K. Schnell
Affiliation:
Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
E. Schramm
Affiliation:
Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
C. Torrent
Affiliation:
Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
D. Wasserman
Affiliation:
National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden
J. Wiersma
Affiliation:
Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands
F. Padberg*
Affiliation:
Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
*
⁎ Corresponding author. Tel.: +49 89 440053358; fax: +49 89 440053930. E-mail address:[email protected] (F. Padberg).
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Abstract

Purpose

Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.

Methods

We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.

Results

We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.

Discussion

The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.

Conclusion

Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.

Keywords

Chronic depressionPersistent depressive disorderAffective disordersPsychotherapyTrauma
Type
Original article
Information
European Psychiatry , Volume 33 , Issue 1 , March 2016 , pp. 18 - 36
Copyright
Copyright © European Psychiatric Association 2016

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Footnotes

1

A. Jobst, E. Schramm, P. Cuijpers, and F. Padberg constituted a core group of 4 authors who developed and wrote the manuscript.

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