Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

2020 ◽  
Vol 124 ◽  
pp. 103512 ◽  
Author(s):  
Ilinca Serbanescu ◽  
Henrik Walter ◽  
Knut Schnell ◽  
Henrik Kessler ◽  
Bernd Weber ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Supportive Psychotherapy ◽  
Baseline Characteristics ◽  
Persistent Depressive Disorder

scholarly journals Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder

2020 ◽  
Vol 11 ◽  
Author(s):  
Ilinca Serbanescu ◽  
Matthias Backenstrass ◽  
Sarah Drost ◽  
Bernd Weber ◽  
Henrik Walter ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Treatment Effectiveness ◽  
Behavioral Analysis ◽  
Social Inhibition ◽  
Depression Severity ◽  
Supportive Psychotherapy ◽  
Baseline Characteristics ◽  
Baseline Levels ◽  
Analysis System ◽  
Persistent Depressive Disorder

Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.

Exploring Interpersonal Relationship of Female Patients with Persistent Depressive Disorder: A Qualitative Study with a Phenomenological Approach

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Fatemeh Asadollahi ◽  
Hamid Taher Neshat Doost ◽  
Mohammad Reza Abedi ◽  
Hamid Afshar Zanjani
Keyword(s):  
Qualitative Study ◽  
Depressive Disorder ◽  
Interpersonal Relationships ◽  
Interpersonal Relationship ◽  
Phenomenological Approach ◽  
Relationship Of ◽  
Depth Interviews ◽  
Chronic Problem ◽  
Persistent Depressive Disorder

Background: Persistent depressive disorder (PDD) is a chronic problem that is more prevalent among women than men. Various studies have revealed that these people experience many problems in their interpersonal relationships, which increase their suffering. Objectives: The present study was done to identify how people suffering from PDD experience interpersonal relationships that often seem troubled and broken. Methods: A phenomenological approach was adopted for this qualitative study. For this purpose, in-depth interviews were conducted with 21 individuals with PDD, focusing on exploring their experience and suffering in interpersonal relationships. All interviews were recorded and transcribed, and the transcripts were analyzed using Giorgi’s phenomenological descriptive method. Results: In general, five main themes and 16 sub-themes emerged. The main themes were: (1) Feeling empty of love and compassion; (2) feeling ignored; (3) ignoring others’ needs, conditions, and suffering; (4) feeling of being annoying to others; and (5) feeling confused and helpless in relationships. Conclusions: It seems that all five themes convey the message that these individuals demonstrate less skill in feeling compassion and receiving it from others. Therefore, it appears that long-term compassion-based interventions can effectively reduce the interpersonal suffering of these individuals. It should be noted that although these themes have commonalities in different cultural contexts, the culture can influence the content and intensity of these feelings.

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

2018 ◽  
Author(s):  
Isabelle E. Bauer ◽  
Antonio L Teixeira ◽  
Marsal Sanches ◽  
Jair C. Soares
Keyword(s):  
Depressive Disorder ◽  
Depressive Disorders ◽  
Treatment Strategies ◽  
Premenstrual Dysphoric Disorder ◽  
Brain Volumes ◽  
Somatic Therapy ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
History Of ◽  
Persistent Depressive Disorder

This review discusses the changes in the diagnostic criteria for depressive disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and recent findings exploring the etiology of and treatment strategies for these disorders. Depressive disorders are typically characterized by depression in the absence of a lifetime history of mania or hypomania. New developments in the DSM-5 include the recognition of new types of depressive disorders, such as disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, and the addition of catatonic features as a specifier for persistent depressive disorder. These diagnostic changes have important implications for the prognosis and treatment of this condition. A thorough understanding of both the clinical phenotype and the biosignature of these conditions is essential to provide individualized, long-term, effective treatments to affected individuals.  This review contains 1 table and 52 references Key words: brain volumes, depressive disorders, DSM-5, hormones, inflammation, neuropeptides, somatic therapy, stress

Persistent Depressive Disorder

2015 ◽  
pp. 226-237
Author(s):  
Daniel N. Klein ◽  
Sarah R. Black
Keyword(s):  
Depressive Disorder ◽  
Future Research ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
The Past ◽  
Psychotherapeutic Interventions ◽  
Interpersonal Difficulties ◽  
Persistent Depression ◽  
Continuation Maintenance ◽  
Persistent Depressive Disorder

Over the past few decades, there has been increasing recognition of the problem of persistent, or chronic, depression. Chronic depressions account for up to a third of the cases of depression in the community and half the cases in clinical practice. Moreover, as reflected in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), persistent depressive disorder differs in many significant respects from nonpersistent depression. This chapter provides an overview of the current literature on persistent depression, starting with classification, epidemiology, and course. Psychosocial and neurobiological risk factors, including early adversity, genetics, personality/temperament, cognitive style, interpersonal difficulties, neural abnormalities, and chronic stress, are then reviewed. Next, we discuss psychopharmacological and psychotherapeutic interventions for acute and continuation/maintenance treatment of persistent depression. We conclude with suggestions for future research.

Persistent Depressive Disorder/Dysthymia

2017 ◽  
pp. 160-166
Author(s):  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Gerald L. Klerman
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorder ◽  
Maintenance Therapy ◽  
Role Transition ◽  
Depressed Woman ◽  
Track Record ◽  
Self Image ◽  
Long Duration ◽  
Current Mood ◽  
Persistent Depressive Disorder

This chapter describes the adaptation of IPT for the treatment of patients with persistent depressive disorder/dysthymia. The usual IPT model connects a recent event in the patient’s life with current mood and symptoms, but for patients who have been depressed for years, this model makes less sense. Instead, the IPT therapist makes the treatment itself a role transition from longstanding depression to euthymia in which patients learn to recognize depressive symptoms of long duration and how they have affected their social functioning. The therapist offers a formulation that shifts the blame for the patient’s situation from the patient to the illness. Treatment includes sixteen weekly sessions to drive these points home, although monthly continuation sessions and maintenance therapy are frequently offered so that patients’ new self-image and track record of healthy interpersonal functioning can sink in. A case example is given of a chronically depressed woman who improves with IPT.

scholarly journals Continuation and maintenance treatments for persistent depressive disorder

2017 ◽  
Author(s):  
Sarah Liebherz ◽  
Katja Machmutow ◽  
Alessa Jansen ◽  
Ramona Meister ◽  
Birgit Watzke ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Persistent Depressive Disorder

scholarly journals Social Cognition and Interpersonal Problems in Persistent Depressive Disorder vs. Episodic Depression: The Role of Childhood Maltreatment

2021 ◽  
Vol 11 ◽  
Author(s):  
Nele Struck ◽  
Thomas Gärtner ◽  
Tilo Kircher ◽  
Eva-Lotta Brakemeier
Keyword(s):  
Social Cognition ◽  
Depressive Disorder ◽  
Childhood Maltreatment ◽  
Interpersonal Problems ◽  
Self Report ◽  
Interpersonal Behavior ◽  
Healthy Controls ◽  
Cross Sectional ◽  
A Current ◽  
Persistent Depressive Disorder

Objective: Little is known about the specific psychological features that differentiate persistent depressive disorder (PDD) and episodic depression (ED). Thus, the present study aimed to investigate differences in social cognition and interpersonal problems between these two forms of depression and healthy controls. In addition, we aimed to examine childhood maltreatment (CM) as a possible origin of these alterations.Methods: In a cross-sectional study, adult patients with a current PDD (n = 34) or in a current episode of ED (n = 38), and healthy controls (n = 39) completed questionnaires about depression severity, empathy, interpersonal problems, and CM, as well as tests of affective theory of mind and facial emotion recognition.Results: Patients with PDD reported higher empathic distress than patients with ED and healthy controls. Both depressive groups recognized angry faces with higher accuracy and reported more interpersonal problems, with no differences between PDD and ED. Empathic distress and interpersonal problems mediated the link between CM and depression in the combined sample.Limitations: Patient groups were not drug-naïve and antidepressant intake might have influenced social-cognitive functions. Self-report measures of empathy and interpersonal problems are vulnerable to bias. The cross-sectional design does not allow causal conclusions.Conclusion: Depressed patients may not show deficits in decoding the affective states of others and in feeling with others. However, depressed individuals—in particular patients with PDD—may feel easily overwhelmed by emotionally tense situations, resulting in empathic distress and avoidant/submissive interpersonal behavior. Exposure to CM might be an origin of alterations in social cognition and interpersonal problems.

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