Breaking the Myths: New Treatment Approaches for Chronic Depression

Abstract

Background: Chronic depressive disorders are common, accounting for approximately one-third of all cases of depression and posing a major public health problem. In the past, chronic depression has been thought to be treatment-resistant, and evidence suggests that it is currently underdiagnosed, misdiagnosed, and suboptimally treated. Objectives: To review the subtypes of chronic depression and the evidence-base concerning their optimal treatment and to discuss some key clinical issues and areas of future research. Methods: We identified key studies and randomized controlled trials (RCTs) by systematically searching electronic databases and hand searching specialist journals and bibliographies. Results: Chronic depressive disorders respond well to standard pharmacologic interventions in the acute and maintenance phases of treatment. Standard psychotherapies alone may not be efficacious for chronic depression (especially dysthymia). Recent evidence suggests that treatment combining psychotherapy and medications may be superior to either treatment alone. Conclusions: Chronic depressive disorders are amenable to treatment, provided that intervention is both thorough and intensive. Although our knowledge about the optimal treatment of chronic depression has developed rapidly, changes in clinical practice have been slower to evolve. Further research is required to assess the effectiveness of multimodal interventions for chronic depression in more naturalistic settings.

A biopsychosocial model as a guide for psychoeducation and treatment of depression

“…Prophylaxis implies influencing patients' psychobiological vulnerability; moreover, one should aim at preventing or minimizing the effects of stressful, traumatic life circumstances [Lam et al, 1996]. Psychotherapeutic interventions that appear to be most effective in the treatment of depression are cognitive-behavioral and interpersonal therapy [e.g., Arean and Cook, 2002;Jarrett et al, 2001;Kornbluh et al, 2001;Lenze et al, 2002;Michalak and Lam, 2002;Nierenberg, 2001;Segal et al, 2002;Thase et al, 1997]. In view of the high risk of relapse [Duggan, 1997], the importance of a long-term treatment of depressive disorders is being increasingly stressed [e.g., Geddes et al, 2003].…”

“…In view of the high risk of relapse [Duggan, 1997], the importance of a long-term treatment of depressive disorders is being increasingly stressed [e.g., Geddes et al, 2003]. There are indications that combinations of psychotherapeutic and pharmacological interventions offer better outcomes in severe depression over extended periods of time than do monotherapies; this applies to improved recovery and to the reduction of the risk of relapse [e.g., Arean and Cook, 2002;Arnow and Constantino, 2003;Lenze et al, 2002;Michalak and Lam, 2002;Segal et al, 2002;Thase et al, 1997]. This superior effect can be achieved, for example, by cognitive-behavioral techniques that concentrate specifically on the residual symptomatology following a response or partial remission resulting from pharmacotherapy .…”

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

“…[9][10][11][12][13] For chronic MDD, a combination of psychotherapy and medication has been found to be the most effective. 14,15 Such diversity of treatment alternatives is necessary, as fewer than 50% of patients fully remit after an adequate trial of antidepressants or psychotherapy. [16][17][18][19] MDD patients who do not fully remit after initial ("Step 1") treatment are thought to have treatment resistant depression, defined as an inadequate response to at least one trial of an antidepressant, at an adequate dose, for 6 weeks or longer.…”

Therapeutic Options for Treatment-Resistant Depression

“…Existing studies of psychotherapy in TRD, particularly cognitive behaviour therapy (CBT) or its derivatives, [22][23][24][25][26][27][28][29][30][31] show effectiveness, but comparative effectiveness is largely unknown. [32] Recently, results from the STAR * D study have been published, in which patients who had not responded to treatment with an SSRI after 12 weeks received an SSRI combined with either CBT or another antidepressant versus an SSRI followed by a switch to either CBT or another antidepressant alone.…”