Kognitive Verhaltenstherapie bei Depressionen im Alter

Hautzinger, Martin; Welz, Stephan

doi:10.1007/s00391-004-0262-x

Cited by 39 publications

(7 citation statements)

References 23 publications

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“…This design decision was taken to ensure a significantly large number of patients in both treatment arms to address the primary research question of the study, namely, the specific efficacy of CBT in LLD. However, symptom changes of waiting-list LLD control groups have been reported in the literature, and the effects we observed in both treatment arms of our study are substantially larger [15, 32–35]. A further limitation is that treatment integrity was not assessed throughout all rated videos by multiple raters using a measure previously shown to be reliable and valid as well as in this sample.…”

Section: Discussionmentioning

confidence: 63%

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Dafsari

Bewernick

Böhringer

et al. 2023

Psychother Psychosom

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Introduction: Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare. Objective: The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting. Methods: In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up. Results: Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (n = 126) or SUI (n = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: −1.01 [95% CI: −2.88 to 0.86]; p = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms. Conclusions: Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT.

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Section: Discussionmentioning

confidence: 63%

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Dafsari

Bewernick

Böhringer

et al. 2023

Psychother Psychosom

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“…The pooled remission rates after completion of therapy were 0.5174 for ICBT and 0.6090 for FCBT. The pooled spontaneous remission rate in the absence of acute treatment for patients in the depressed state was 0.0123 [ 42 , 63 – 67 , 71 , 72 ]. Relapse rates were 0.0064 after full remission (after treatment completion) [ 39 – 47 ] and 0.0202 after spontaneous remission [ 48 ].…”

Section: Methodsmentioning

confidence: 99%

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Baumann

Stargardt

Frey

2020

Appl Health Econ Health Policy

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Background and Objective Unipolar depression is the most common form of depression and demand for treatment, such as psychotherapy, is high. However, waiting times for psychotherapy often considerably exceed their recommended maximum. As a potentially less costly alternative treatment, internet-based cognitive behavior therapy (ICBT) might help reduce waiting times. We therefore analyzed the cost-utility of ICBT compared to face-to-face CBT (FCBT) as an active control treatment, taking differences in waiting time into account. Methods We constructed a Markov model to simulate costs and health outcomes measured in quality-adjusted life years (QALYs) for ICBT and FCBT in Germany. We modeled a time horizon of 3 years using six states (remission, depressed, spontaneous remission, undergoing treatment, treatment finished, death). The societal perspective was adopted. We obtained parameters for transition probabilities, depression-specific QoL, and cost data from the literature. Deterministic and probabilistic sensitivity analyses were conducted. Within a scenario analysis, we simulated different time-to-treatment combinations. Half-cycle correction was applied. Results In our simulation, ICBT generated 0.260 QALYs and saved €2536 per patient compared to FCBT. Our deterministic sensitivity analysis suggests that the base-case results were largely unaffected by parameter uncertainty and are therefore robust. Our probabilistic sensitivity analysis suggests that ICBT is highly likely to be more effective (91.5%), less costly (76.0%), and the dominant strategy (69.7%) compared to FCBT. The scenario analysis revealed that the base-case results are robust to variations in time-to-treatment differences. Conclusion ICBT has a strong potential to balance demand and supply of CBT in unipolar depression by reducing therapist time per patient. It is highly likely to generate more QALYs and reduce health care expenditure. In addition, ICBT may have further positive external effects, such as freeing up capacities for the most severely depressed patients.

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“…In a recent review, Jonsson et al46 examined 22 RCTs that had evaluated the effectiveness of different forms of psychotherapy in older depressed patients, and they found that problem-solving therapy had a large and heterogeneous effect size compared with usual care, whereas the evidence for the effectiveness of cognitive behavioral therapy (CBT) and reminiscence therapy (also known as life review therapy) was insufficient due to small study numbers, heterogeneity of interventions, and a high risk of bias. Hautzinger and Welz47 compared CBT with a waitlist control group and found that CBT was superior to the control in reducing depressive symptoms and in producing remission rates posttreatment and at follow-up intervals in depressed older outpatients. The effectiveness of psychotherapy in older depressed patients was also supported by findings from Peng et al48 who found that CBT and reminiscence therapy were both more effective than placebo with no significant difference between either form of therapy.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to pharmacotherapy, psychotherapy should also be provided to patients with LLD as it has been found to be efficacious, especially in the form of individual sessions of CBT and problem-solving therapy 47,48. As no potential pharmacological interaction has to be considered, psychotherapy is safe in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Therapy Strategies for Late-life Depression: A Review

Piel

Quante

2023

Journal of Psychiatric Practice

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Background: Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. Methods: A literature search in Medline/ PubMed performed in June 2020 identified 83 relevant studies. Results: Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but > 50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication. Limitations: LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted. Conclusions: Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.

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Kognitive Verhaltenstherapie bei Depressionen im Alter

Abstract: Cognitive behavioral group treatment is a well accepted, successful intervention for older adults. Waiting for treatment is problematic. It does not only produce no changes in symptomatology but even leads to worsening of depression in a large number of subjects.

Cited by 39 publications

References 23 publications

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Therapy Strategies for Late-life Depression: A Review

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