European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

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).

Article contents

Abstract
Footnotes
References

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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 depression Persistent depressive disorder Affective disorders Psychotherapy Trauma

Type: Original article
Information: European Psychiatry , Volume 33 , Issue 1 , March 2016 , pp. 18 - 36

DOI: https://doi.org/10.1016/j.eurpsy.2015.12.003 [Opens in a new window]
Copyright: Copyright © European Psychiatric Association 2016

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Footnotes

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

References

Angst, J.Gamma, A.Rossler, W.Ajdacic, V.Klein, D.N.Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. J Affect Disord 2009; 115: 112–121CrossRef Google Scholar PubMed

Arnow, B.A.Constantino, M.J.Effectiveness of psychotherapy and combination treatment for chronic depression. J Clin Psychol 2003; 59: 893–905CrossRef Google Scholar PubMed

Gilmer, W.S.Gollan, J.K.Wisniewski, S.R.Howland, R.H.Trivedi, M.H.Miyahara, S., et al.Does the duration of index episode affect the treatment outcome of major depressive disorder?. A STAR*D report J Clin Psychiatry 2008; 69: 1246–1256CrossRef Google Scholar PubMed

Kessler, R.C.McGonagle, K.A.Zhao, S.Nelson, C.B.Hughes, M.Eshleman, S., et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey Arch Gen Psychiatry 1994; 51: 8–19CrossRef Google Scholar PubMed

Spijker, J.de Graaf, R.Bijl, R.V.Beekman, A.T.Ormel, J.Nolen, W.A.Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Br J Psychiatry 2002; 181: 208–213CrossRef Google Scholar

Torpey, D.C.Klein, D.N.Chronic depression: update on classification and treatment. Curr Psychiatry Rep 2008; 10: 458–464CrossRef Google Scholar PubMed

Kessler, R.C.Berglund, P.Demler, O.Jin, R.Merikangas, K.R.Walters, E.E.Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 593–602CrossRef Google Scholar PubMed

Murphy, J.A.Byrne, G.J.Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. J Affect Disord 2012; 139: 172–180CrossRef Google Scholar PubMed

Blanco, C.Okuda, M.Markowitz, J.C.Liu, S.M.Grant, B.F.Hasin, D.S.The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2010; 71: 1645–1656CrossRef Google Scholar PubMed

Satyanarayana, S.Enns, M.W.Cox, B.J.Sareen, J.Prevalence and correlates of chronic depression in the canadian community health survey: mental health and well-being. Can J Psychiatry 2009; 54: 389–398CrossRef Google Scholar PubMed

Lopez, A.D.Mathers, C.D.Ezzati, M.Jamison, D.T.Murray, C.J.Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367: 1747–1757CrossRef Google Scholar PubMed

Smit, F.Cuijpers, P.Oostenbrink, J.Batelaan, N.de Graaf, R.Beekman, A.Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 2006; 9: 193–200Google Scholar PubMed

Howland, R.H.Chronic depression. Hosp Community Psychiatry 1993; 44: 633–639Google Scholar PubMed

Wells, K.B.Burnam, M.A.Rogers, W.Hays, R.Camp, P.The course of depression in adult outpatients. Results from the Medical Outcomes Study. Arch Gen Psychiatry 1992; 49: 788–794CrossRef Google Scholar PubMed

Rhebergen, D.Beekman, A.T.de Graaf, R.Nolen, W.A.Spijker, J.Hoogendijk, W.J., et al.Trajectories of recovery of social and physical functioning in major depression, dysthymic disorder and double depression: a 3-year follow-up J Affect Disord 2010; 124: 148–156CrossRef Google Scholar PubMed

Arnow, B.A.Manber, R.Blasey, C.Klein, D.N.Blalock, J.A.Markowitz, J.C., et al.Therapeutic reactance as a predictor of outcome in the treatment of chronic depression J Consult Clin Psychol 2003; 71: 1025–1035CrossRef Google Scholar PubMed

Thase, M.E.Preventing relapse and recurrence of depression: a brief review of therapeutic options. CNS Spectr 2006; 11: 12–21CrossRef Google Scholar PubMed

Thase, M.E.Friedman, E.S.Howland, R.H.Management of treatment-resistant depression: psychotherapeutic perspectives. J Clin Psychiatry 2001; 62(Suppl. 18):18–24Google Scholar PubMed

APA, American Psychiatric Association (APA): Diagnostic & statistical manual of mental disorders, ed. 4, revised 2001 APA Washington DCGoogle Scholar

Keller, M.B.Klein, D.N.Hirschfeld, R.M.Kocsis, J.H.McCullough, J.P.Miller, I., et al.Results of the DSM-IV mood disorders field trial Am J Psychiatry 1995; 152: 843–849Google Scholar PubMed

Klein, D.N.Classification of depressive disorders in the DSM-V: proposal for a two-dimension system. J Abnorm Psychol 2008; 117: 552–560CrossRef Google Scholar PubMed

Klein, D.N.Shankman, S.A.Rose, S.Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry 2006; 163: 872–880CrossRef Google Scholar PubMed

Weissmann, M.M.Leaf, P.J.Bruce, M.L.Florio, L.The epidemiology of dysthymia in five communities: rates, risks, co-morbiditiy, and treatment. Am J Psychiatr 1988; 145: 815–819Google Scholar

Kessler, R.C.Chiu, W.T.Demler, O.Merikangas, K.R.Walters, E.E.Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 617–627CrossRef Google Scholar PubMed

Lyketsos, C.G.Nestadt, G.Cwi, J.Heithoff, K.Eaton, W.W.The life chart interview: a standardized method to describe the course of psychopathology. Int J Methods Psychiatr Res 1994; 4: 143–155Google Scholar

Cassano, G.B.Akiskal, H.S.Perugi, G.Musetti, L.Savino, M.The importance of measures of affective temperaments in genetic studies of mood disorders. J Psychiatr Res 1992; 26: 257–268CrossRef Google Scholar PubMed

Keller, M.B.McCullough, J.P.Klein, D.N.Arnow, B.Dunner, D.L.Gelenberg, A.J., et al.A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression N Engl J Med 2000; 342: 1462–1470CrossRef Google Scholar PubMed

Klein, D.N.Schatzberg, A.F.McCullough, J.P.Keller, M.B.Dowling, F.Goodman, D., et al.Early- versus late-onset dythymic disorder: comparison in out-patients with superimposed major depressive episodes J Affect Disord 1999; 52: 187–196CrossRef Google Scholar PubMed

Ruhe, H.G.van Rooijen, G.Spijker, J.Peeters, F.P.Schene, A.H.Staging methods for treatment resistant depression. A systematic review. J Affect Disord 2012; 137: 35–45CrossRef Google Scholar PubMed

Nemeroff, C.B.Prevalence and management of treatment-resistant depression. J Clin Psychiatry 2007; 68(Suppl. 8):17–25Google Scholar PubMed

Rush, A.J.Thase, M.E.Dube, S.Research issues in the study of difficult-to-treat depression. Biol Psychiatry 2003; 53: 743–753CrossRef Google Scholar

Sackeim, H.A.The definition and meaning of treatment-resistant depression. J Clin Psychiatr 2001; 62(Suppl. 16):10–17Google Scholar PubMed

Souery, D.Papakostas, G.I.Trivedi, M.H.Treatment-resistant depression. J Clin Psychiatry 2006; 67(Suppl. 6):16–22Google Scholar PubMed

Kocsis, J.H.Gelenberg, A.J.Rothbaum, B.Klein, D.N.Trivedi, M.H.Manber, R., et al.Chronic forms of major depression are still undertreated in the 21st century: systematic assessment of 801 patients presenting for treatment J Affect Disord 2008; 110: 55–61CrossRef Google Scholar PubMed

Brown, G.W.Craig, T.K.Harris, T.O.Parental maltreatment and proximal risk factors using the Childhood Experience of Care & Abuse (CECA) instrument: a life-course study of adult chronic depression - 5. J Affect Disord 2008; 110: 222–233CrossRef Google Scholar PubMed

Dougherty, L.R.Klein, D.N.Davila, J.A growth curve analysis of the course of dysthymic disorder: the effects of chronic stress and moderation by adverse parent-child relationships and family history. J Consult Clin Psychol 2004; 72: 1012–1021CrossRef Google Scholar PubMed

Durbin, C.E.Klein, D.N.Schwartz, J.E.Predicting the 2 1/2-year outcome of dysthymic disorder: the roles of childhood adversity and family history of psychopathology. J Consult Clin Psychol 2000; 68: 57–63CrossRef Google Scholar PubMed

Klein, D.N.Arnow, B.A.Barkin, J.L.Dowling, F.Kocsis, J.H.Leon, A.C., et al.Early adversity in chronic depression: clinical correlates and response to pharmacotherapy Depress Anxiety 2009; 26: 701–710CrossRef Google Scholar PubMed

Klein, D.N.Santiago, N.J.Dysthymia and chronic depression: introduction, classification, risk factors, and course. J Clin Psychol 2003; 59: 807–816CrossRef Google Scholar PubMed

Wiersma, J.E.Hovens, J.G.van Oppen, P.Giltay, E.J.van Schaik, D.J.Beekman, A.T., et al.The importance of childhood trauma and childhood life events for chronicity of depression in adults J Clin Psychiatry 2009; 70: 983–989CrossRef Google Scholar PubMed

Teicher, M.H.Samson, J.A.Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. Am J Psychiatry 2013; 170: 1114–1133CrossRef Google Scholar PubMed

Angst, J.Gamma, A.Rossler, W.Ajdacic, V.Klein, D.N.Childhood adversity and chronicity of mood disorders. Eur Arch Psychiatry Clin Neurosci 2011; 261: 21–27CrossRef Google Scholar PubMed

Chu, D.A.Williams, L.M.Harris, A.W.Bryant, R.A.Gatt, J.M.Early life trauma predicts self-reported levels of depressive and anxiety symptoms in nonclinical community adults: relative contributions of early life stressor types and adult trauma exposure. J Psychiatr Res 2013; 47: 23–32CrossRef Google Scholar PubMed

Lizardi, H.Klein, D.N.Ouimette, P.C.Riso, L.P.Anderson, R.L.Donaldson, S.K.Reports of the childhood home environment in early-onset dysthymia and episodic major depression. J Abnorm Psychol 1995; 104: 132–139CrossRef Google Scholar PubMed

Wiersma, J.E.van Schaik, D.J.van Oppen, P.McCullough, J.P. Jr.Schoevers, R.A.Dekker, J.J., et al.Treatment of chronically depressed patients: a multisite randomized controlled trial testing the effectiveness of ‘Cognitive Behavioral Analysis System of Psychotherapy’ (CBASP) for chronic depressions versus usual secondary care. BMC Psychiatry 2008; 8:18CrossRef Google Scholar PubMed

Carr, C.P.Martins, C.M.Stingel, A.M.Lemgruber, V.B.Juruena, M.F.The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes. J Nerv Ment Dis 2013; 201: 1007–1020CrossRef Google Scholar PubMed

Kestenbaum, C.J.Childhood precursors of personality disorders: evaluation and treatment. Psychodyn Psychiatry 2012; 40: 111–130CrossRef Google Scholar PubMed

Newnham, E.A.Janca, A.Childhood adversity and borderline personality disorder: a focus on adolescence. Curr Opin Psychiatry 2014; 27: 68–72CrossRef Google Scholar PubMed

Klein, D.Chronic depression: diagnosis and classification. Curr Direct Psychol Sci 2010; 19: 96–100CrossRef Google Scholar

Rothschild, L.Zimmerman, M.Personality disorders and the duration of depressive episode: a retrospective study. J Personal Disord 2002; 16: 293–303CrossRef Google Scholar PubMed

Klein, J.P.Roniger, A.Schweiger, U.Spath, C.Brodbeck, J.The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients. J Clin Psychiatr 2015; 76:e794–e801CrossRef Google Scholar PubMed

Gilmer, W.S.Trivedi, M.H.Rush, A.J.Wisniewski, S.R.Luther, J.Howland, R.H., et al.Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project Acta Psychiatr Scand 2005; 112: 425–433CrossRef Google Scholar PubMed

Holzel, L.Harter, M.Reese, C.Kriston, L.Risk factors for chronic depression--a systematic review. J Affect Disord 2011; 129: 1–13CrossRef Google Scholar PubMed

Maddux, R.E.Riso, L.P.Klein, D.N.Markowitz, J.C.Rothbaum, B.O.Arnow, B.A., et al.Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination J Affect Disord 2009; 117: 174–179CrossRef Google Scholar PubMed

Russell, J.M.Kornstein, S.G.Shea, M.T.McCullough, J.P.Harrison, W.M.Hirschfeld, R.M., et al.Chronic depression and comorbid personality disorders: response to sertraline versus imipramine J Clin Psychiatr 2003; 64: 554–561CrossRef Google Scholar PubMed

Enns, M.W.Cox, B.J.Psychosocial and clinical predictors of symptom persistence vs remission in major depressive disorder. Can J Psychiatry 2005; 50: 769–777CrossRef Google Scholar PubMed

Wiersma, J.E.van Oppen, P.van Schaik, D.J.van der Does, A.J.Beekman, A.T.Penninx, B.W.Psychological characteristics of chronic depression: a longitudinal cohort study. J Clin Psychiatry 2011; 72: 288–294CrossRef Google Scholar PubMed

Riso, L.P.Miyatake, R.K.Thase, M.E.The search for determinants of chronic depression: a review of six factors. J Affect Disord 2002; 70: 103–115CrossRef Google Scholar PubMed

Constantino, M.J.Manber, R.Degeorge, J.McBride, C.Ravitz, P.Zuroff, D.C., et al.Interpersonal styles of chronically depressed outpatients: Profiles and therapeutic change Psychotherapy (Chic) 2008; 45: 491–506CrossRef Google Scholar PubMed

Ley, P.Helbig-Lang, S.Czilwik, S.Lang, T.Worlitz, A.Brucher, K., et al.Phenomenological differences between acute and chronic forms of major depression in inpatients Nord J Psychiatry 2011; 65: 330–337CrossRef Google Scholar PubMed

Schramm, E.Klein, J.Cognitive Behavioral Analysis System of Psychotherapy - Störungsspezifische Behandlung chronischer Depressionen Neurotransmitter 2012 5Google Scholar

Field, T.Diego, M.Hernandez-Reif, M.Ascencio, A.Prenatal dysthymia versus major depression effects on early mother-infant interactions: a brief report. Infant Behav Dev 2009; 32: 129–131CrossRef Google Scholar PubMed

McCullough, J.P.Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP) New York: The Guilford Press; 2000Google Scholar

McCullough, J.P. Jr.Treatment for chronic depression using Cognitive Behavioral Analysis System of Psychotherapy (CBASP). J Clin Psychol 2003; 59: 833–846CrossRef Google Scholar

Caspar, F.Walter, H.Schnell, K.Entwicklungspsychologische Grundlagen München: Elsevier; 2013Google Scholar

Kuhnen, T.Knappke, F.Otto, T.Friedrich, S.Klein, J.P.Kahl, K.G., et al.Chronic depression: development and evaluation of the luebeck questionnaire for recording preoperational thinking (LQPT). BMC Psychiatry 2011; 11:199CrossRef Google Scholar

Wilbertz, G.Brakemeier, E.L.Zobel, I.Harter, M.Schramm, E.Exploring preoperational features in chronic depression. J Affect Disord 2010; 124: 262–269CrossRef Google Scholar PubMed

Michalak, E.E.Lam, R.W.Breaking the myths: new treatment approaches for chronic depression. Can J Psychiatry 2002; 47: 635–643CrossRef Google Scholar PubMed

Schramm, E.Zobel, I.Dykierek, P.Kech, S.Brakemeier, E.L.Kulz, A., et al.Cognitive behavioral analysis system of psychotherapy versus interpersonal psychotherapy for early-onset chronic depression: a randomized pilot study J Affect Disord 2011; 129: 109–116CrossRef Google Scholar PubMed

Thase, M.E.Kingdon, D.Turkington, D.The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments. World Psychiatry 2014; 13: 244–250CrossRef Google Scholar PubMed

Caspar, F.Beziehungsgestaltung München: Elsevier; 2013CrossRef Google Scholar

Nanni, V.Uher, R.Danese, A.Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry 2012; 169: 141–151CrossRef Google Scholar PubMed

McCullough, J.P.Cognitive-behavioral analysis system of psychotherapy: an interactional treatment approach for dysthymic disorder. Psychiatry 1984; 47: 234–250CrossRef Google Scholar PubMed

Keitner, G.I.Ryan, C.E.Solomon, D.A.Realistic expectations and a disease management model for depressed patients with persistent symptoms. J Clin Psychiatry 2006; 67: 1412–1421CrossRef Google Scholar

Kriston, L.von Wolff, A.Holzel, L.Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON). BMC Psychiatry 2010; 10:95CrossRef Google Scholar

Markowitz, J.C.Psychotherapy of dysthymia. Am J Psychiatry 1994; 151: 1114–1121Google Scholar PubMed

Rush, A.J.Thase, M.E.Strategies and tactics in the treatment of chronic depression. J Clin Psychiatr 1997; 58(Suppl. 13):14–22Google Scholar PubMed

Spijker, J.van Straten, A.Bockting, C.L.Meeuwissen, J.A.van Balkom, A.J.Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review. Can J Psychiatry 2013; 58: 386–392CrossRef Google Scholar PubMed

von Wolff, A.Holzel, L.P.Westphal, A.Harter, M.Kriston, L.Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: a systematic review and meta-analysis. BMC Psychiatry 2012; 12:61CrossRef Google Scholar PubMed

Cuijpers, P.van Straten, A.Schuurmans, J.van Oppen, P.Hollon, S.D.Andersson, G.Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clin Psychol Rev 2010; 30(1): 51–62CrossRef Google Scholar PubMed

Kriston, L.von Wolff, A.Westphal, A.Holzel, L.P.Harter, M.Efficacy and acceptability of acute treatments for persistent depressive disorder: A network meta-analysisDepress Anxiety 2014Google Scholar

Gaebel, W.Becker, T.Janssen, B.Munk-Jorgensen, P.Musalek, M.Rossler, W., et al.EPA guidance on the quality of mental health services Eur Psychiatry 2012; 27: 87–113CrossRef Google Scholar PubMed

Gaebel, W.Muijen, M.Baumann, A.E.Bhugra, D.Wasserman, D.van der Gaag, R.J., et al.EPA guidance on building trust in mental health services Eur Psychiatry 2014; 29: 83–100CrossRef Google Scholar PubMed

NICE, Depression in adults: The treatment and management of depression in adults 2009 ed: National Institute for Health and Care Excellence http://www.nice.org.uk/guidance/CG90 Google Scholar

APA, Practice Guideline for the Treatment of Patients with Major Depressive Disorder 3rd ed 2010 APAGoogle Scholar

Parikh, S.V.Segal, Z.V.Grigoriadis, S.Ravindran, A.V.Kennedy, S.H.Lam, R.W., et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. J Affect Disord 2009; 117(Suppl. 1):S15–S25CrossRef Google Scholar PubMed

DGPPN, S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression 2009 www.dgppn.de, www.versorgungsleitlinien.de, www.awmf-leitlinien.deGoogle Scholar

SIGN, SIGN 50: A guideline developer's handbook 2011 Scottish Intercollegiate Guidelines NetworkGoogle Scholar

EPA, Manual on the Methodological Requirements for Developing European Psychiatric Association (EPA) Guidance Documents. EPA Guidance Committee: Chair: W Gaebel (Düsseldorf), Co-chair: HJ Möller (Munich), Members: D Wasserman (Stockholm), D Bhugra (London), P Falkai (Munich), A Fiorillo (Naples), R Heun (Derby), M Musalek (Vienna) 2013 (revised 17.10.2013)Google Scholar

NICE, National Institute for Health and Care Excellence - Depression in adults quality standard. NICE quality standard 8: guidance. nice. org. uk/qs8 2011Google Scholar

Härter, M.Klesse, C.Bermejo, I.Schneider, F.Berger, M.Unipolar depression: diagnostic and therapeutic recommendations from the current S3/National Clinical Practice Guideline. Dtsch Arztebl Int 2010; 107: 700–708Google Scholar PubMed

Shinohara, K.Honyashiki, M.Imai, H.Hunot, V.Caldwell, D.M.Davies, P., et al.Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013; 10:CD008696Google Scholar

Hunot, V.Moore, T.H.Caldwell, D.M.Furukawa, T.A.Davies, P.Jones, H., et al.‘Third wave’ cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013; 10:CD008704Google Scholar

Cuijpers, P.Andersson, G.Donker, T.van Straten, A.Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry 2011; 65: 354–364CrossRef Google Scholar PubMed

Imel, Z.E.Malterer, M.B.McKay, K.M.Wampold, B.E.A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord 2008; 110: 197–206CrossRef Google Scholar PubMed

Ravindran, A.V.Anisman, H.Merali, Z.Charbonneau, Y.Telner, J.Bialik, R.J., et al.Treatment of primary dysthymia with group cognitive therapy and pharmacotherapy: clinical symptoms and functional impairments Am J Psychiatry 1999; 156: 1608–1617CrossRef Google Scholar PubMed

Hellerstein, D.J.Little, S.A.Samstag, L.W.Batchelder, S.Muran, J.C.Fedak, M., et al.Adding group psychotherapy to medication treatment in dysthymia: a randomized prospective pilot study J Psychother Pract Res 2001; 10: 93–103Google Scholar PubMed

De Jong, R.Treiber, R.Henrick, G.Effectiveness of two psychological treatments for patients with severe and chronic depressionCogn Ther Res 1986 10Google Scholar

Agosti, V.Ocepek-Welikson, K.The efficacy of imipramine and psychotherapy in early-onset chronic depression: a reanalysis of the National Institute of Mental health Treatment of Depression Collaborative Research Program. J Affect Disord 1997; 43: 181–186CrossRef Google Scholar PubMed

Dunner, D.L.Schmaling, K.B.Hendrickson, H.Becker, J.Lehman, A.Bea, C.Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression 1996; 4: 34–413.0.CO;2-F>CrossRef Google Scholar PubMed

Barker, W.A.Scott, J.Eccleston, D.The Newcastle chronic depression study: results of a treatment regime. Int Clin Psychopharmacol 1987; 2: 261–272CrossRef Google Scholar PubMed

Miller, I.W.Norman, W.H.Keitner, G.I.Combined treatment for patients with double depression. Psychother Psychosom 1999; 68: 180–185CrossRef Google Scholar PubMed

Harpin, R.E.Liberman, R.P.Marks, I.Stern, R.Bohannon, W.E.Cognitive-behavior therapy for chronically depressed patients. A controlled pilot study. J Nerv Ment Dis 1982; 170: 295–301CrossRef Google Scholar PubMed

Hollon, S.D.DeRubeis, R.J.Fawcett, J.Amsterdam, J.D.Shelton, R.C.Zajecka, J., et al.Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial JAMA Psychiatry 2014; 71: 1157–1164CrossRef Google Scholar PubMed

Brakemeier, E.L.Merkl, A.Wilbertz, G.Quante, A.Regen, F.Buhrsch, N., et al.Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial Biol Psychiatry 2014; 76: 194–202CrossRef Google Scholar PubMed

Schramm, E.Caspar, F.Berger, M.A specific therapy for chronic depression. McCullough's Cognitive Behavioral Analysis System of Psychotherapy. Nervenarzt 2006; 77: 355–370 quiz 71CrossRef Google Scholar PubMed

Brakemeier, E.L.Engel, V.Schramm, E.Zobel, I.Schmidt, T.Hautzinger, M., et al.Feasibility and outcome of cognitive behavioral analysis system of psychotherapy (CBASP) for chronically depressed inpatients: a pilot study Psychother Psychosom 2011; 80: 191–194CrossRef Google Scholar PubMed

Wiersma, J.E.van Schaik, D.J.Blom, M.B.Bakker, L.van Oppen, P.Beekman, A.T.Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP). Tijdschr Psychiatr 2009; 51: 727–736Google Scholar

Klein, D.N.Santiago, N.J.Vivian, D.Blalock, J.A.Kocsis, J.H.Markowitz, J.C., et al.Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression J Consult Clin Psychol 2004; 72: 681–688CrossRef Google Scholar PubMed

Klein, J.P.Steinlechner, S.Sipos, V.Schweiger, U.Psychotherapy of chronic depression with cognitive behavioral analysis system of psychotherapy (CBASP). Psychother Psychosom Med Psychol 2011; 61: 526–534 [quiz 35]CrossRef Google Scholar

Kramer, U.Belz, M.Caspar, F.Psychotherapy of chronic depression: contributions of CBASP by McCullough. Encephale 2013; 39: 137–142CrossRef Google Scholar PubMed

Schatzberg, A.F.Rush, A.J.Arnow, B.A.Banks, P.L.Blalock, J.A.Borian, F.E., et al.Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not Arch Gen Psychiatry 2005; 62: 513–520CrossRef Google Scholar PubMed

Schramm, E.Zobel, I.Schoepf, D.Fangmeier, T.Schnell, K.Walter, H., et al.Cognitive Behavioral Analysis System of psychotherapy versus Escitalopram in chronic major depression Psychother Psychosom 2015; 84(4): 227–240CrossRef Google Scholar PubMed

Kocsis, J.H.Gelenberg, A.J.Rothbaum, B.O.Klein, D.N.Trivedi, M.H.Manber, R., et al.Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial Arch Gen Psychiatry 2009; 66: 1178–1188CrossRef Google Scholar PubMed

Fava, M.Rush, A.J.trivedi, M.H.Nierenberg, A.A.Thase, M.E.Sackeim, H.A., et al.Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatr Clin N Am 2003; 26(2)CrossRef Google Scholar PubMed

Schramm, E.Reynolds, C.Where do we go from here? Letter to the editorArch Gen Psychiatr 2010 [online 9 Feb]Google Scholar

Wiersma, J.E.Van Schaik, D.J.Hoogendorn, A.W.Dekker, J.J.Van, H.L.Schoevers, R.A., et al.The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial Psychother Psychosom 2014; 83: 263–269CrossRef Google Scholar PubMed

Michalak, J.Schultze, M.Heidenreich, T.Schramm, E.A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. J Consult Clin Psychol 2015; 83(5): 951–963CrossRef Google Scholar

Schramm, E.Hautzinger, M.Zobel, I.Kriston, L.Berger, M.Harter, M.Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus supportive psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial. BMC Psychiatry 2011; 11:134CrossRef Google Scholar PubMed

Brakemeier, E.L.Radtke, M.Engel, V.Zimmermann, J.Tuschen-Caffier, B.Hautzinger, M., et al.Overcoming treatment resistance in chronic depression: a pilot study on outcome and feasibility of the cognitive behavioral analysis system of psychotherapy as an inpatient treatment program Psychother Psychosom 2015; 84: 51–56CrossRef Google Scholar PubMed

Swan, J.S.Macvicar, R.Christmas, D.Durham, R.Rauchhaus, P.McCullough, J.P. Jr., et al.Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for chronic depression: Clinical characteristics and six month clinical outcomes in an open case series. J Affect Disord 2014; 152-154:268–276CrossRef Google Scholar

Klein, J.P.Becker, B.Hurlemann, R.Scheibe, C.Colla, M.Heuser, I.Effect of specific psychotherapy for chronic depression on neural responses to emotional faces. J Affect Disord 2014; 166: 93–97CrossRef Google Scholar PubMed

Klerman, G.L.Weissman, M.Rounsaville, B.J.Chevron, E.S.Interpersonl Psychotherapy for Depression New York: Basic Books; 1984Google Scholar

Browne, G.Steiner, M.Roberts, J.Gafni, A.Byrne, C.Dunn, E., et al.Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs J Affect Disord 2002; 68: 317–330CrossRef Google Scholar PubMed

Markowitz, J.C.Kocsis, J.H.Bleiberg, K.L.Christos, P.J.Sacks, M.A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients. J Affect Disord 2005; 89: 167–175CrossRef Google Scholar PubMed

Markowitz, J.C.Kocsis, J.H.Christos, P.Bleiberg, K.Carlin, A.Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence. J Nerv Ment Dis 2008; 196: 468–474CrossRef Google Scholar PubMed

Schramm, E.Schneider, D.Zobel, I.van Calker, D.Dykierek, P.Kech, S., et al.Efficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients J Affect Disord 2008; 109: 65–73CrossRef Google Scholar PubMed

de Mello, M.F.Myczcowisk, L.M.Menezes, P.R.A randomized controlled trial comparing moclobemide and moclobemide plus interpersonal psychotherapy in the treatment of dysthymic disorder. J Psychother Pract Res 2001; 10: 117–123Google Scholar PubMed

Linehan, M.M.Cognitive-Behavioral Treatment of Borderline Personality Disorder New York: Guiltford; 1993Google Scholar

Lynch, T.R.Cheavens, J.S.Cukrowicz, K.C.Thorp, S.R.Bronner, L.Beyer, J.Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. Int J Geriatr Psychiatry 2007; 22: 131–143CrossRef Google Scholar PubMed

Lynch, T.R.Morse, J.Q.Mendelson, T.Robins, C.J.Dialectical behavior therapy for depressed older adults: a randomized pilot study. Am J Geriatr Psychiatry 2003; 11: 33–45CrossRef Google Scholar PubMed

Lynch, T.R.Dialectical Behavioral Therapy (DBT) for Treatment-Resistant Depression (TRD): A Randomized Controlled Trial (RCT) 2012 http://www.nets.nihr.ac.uk/_data/assets/pdf_file/0004/45805/PRO-09-150-12.pdf Google Scholar

Driessen, E.Cuijpers, P.de Maat, S.C.Abbass, A.A.de Jonghe, F.Dekker, J.J.The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev 2010; 30: 25–36CrossRef Google Scholar PubMed

Huber, D.Henrich, G.Clarkin, J.Klug, G.Psychoanalytic versus psychodynamic therapy for depression: a three-year follow-up study. Psychiatry 2013; 76: 132–149CrossRef Google Scholar PubMed

de Maat, S.M.Dekker, J.Schoevers, R.A.de Jonghe, F.Relative efficacy of psychotherapy and combined therapy in the treatment of depression: a meta-analysis. Eur Psychiatry 2007; 22: 1–8CrossRef Google Scholar PubMed

Leichsenring, F.Rabung, S.Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008; 300: 1551–1565CrossRef Google Scholar PubMed

Leichsenring, F.Rabung, S.Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. Br J Psychiatry 2011; 199: 15–22CrossRef Google Scholar PubMed

Leichsenring, F.Schauenburg, H.Empirically supported methods of short-term psychodynamic therapy in depression - towards an evidence-based unified protocol. J Affect Disord 2014; 169: 128–143CrossRef Google Scholar PubMed

Buchheim, A.Viviani, R.Kessler, H.Kachele, H.Cierpka, M.Roth, G., et al.Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PLoS One 2012; 7:e33745CrossRef Google Scholar PubMed

Huber, D.Zimmermann, J.Henrich, G.Klug, G.Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients - a three-year follow-up study. Z Psychosom Med Psychother 2012; 58: 299–316Google Scholar PubMed

Zimmermann, J.Loffler-Stastka, H.Huber, D.Klug, G.Alhabbo, S.Bock, A., et al.Is it all about the higher dose? Why psychoanalytic therapy is an effective treatment for major depression Clin Psychol Psychother 2014Google Scholar PubMed

Fonagy, P.Rost, F.Carlyle, J.A.McPherson, S.Thomas, R.Pasco Fearon, R.M., et al.Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS) World Psychiatry 2015; 14: 312–321CrossRef Google Scholar

Beutel, M.E.Leuzinger-Bohleber, M.Ruger, B.Bahrke, U.Negele, A.Haselbacher, A., et al.Psychoanalytic and cognitive-behavior therapy of chronic depression: study protocol for a randomized controlled trial. Trials 2012; 13:117CrossRef Google Scholar PubMed

Young, J.Klosko, J.Weishaar, M.Schema Therapy:, A Practitioners Guide New York: Guiltford Press; 2003Google Scholar

Carter, J.D.McIntosh, V.V.Jordan, J.Porter, R.J.Frampton, C.M.Joyce, P.R.Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. J Affect Disord 2013; 151: 500–505CrossRef Google Scholar PubMed

Renner, F.Arntz, A.Leeuw, I.Huibers, M.Treatment of Chronic DepressionClin Psychol Sci Pract 2013 166–180Google Scholar

Malogiannis, I.A.Arntz, A.Spyropoulou, A.Tsartsara, E.Aggeli, A.Karveli, S., et al.Schema therapy for patients with chronic depression: a single case series study J Behav Ther Exp Psychiatry 2014; 45: 319–329CrossRef Google Scholar PubMed

Barnhofer, T.Crane, C.Hargus, E.Amarasinghe, M.Winder, R.Williams, J.M.Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behav Res Ther 2009; 47: 366–373CrossRef Google Scholar PubMed

Strauss, C.Hayward, M.Chadwick, P.Group person-based cognitive therapy for chronic depression: a pilot randomized controlled trial. Br J Clin Psychol 2012; 51: 345–350CrossRef Google Scholar PubMed

Williams, J.W. Jr.Barrett, J.Oxman, T.Frank, E.Katon, W.Sullivan, M., et al.Treatment of dysthymia and minor depression in primary care: A randomized controlled trial in older adults. JAMA 2000; 284: 1519–1526CrossRef Google Scholar PubMed

Barrett, J.E.Williams, J.W. Jr.Oxman, T.E.Frank, E.Katon, W.Sullivan, M., et al.Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years J Fam Pract 2001; 50: 405–412Google Scholar PubMed

Arnow, B.A.Blalock, J.A.Rothbaum, B.O.McCullough, J.P.Markowitz, J.C.Barlow, D.H.Comparison of medication, psychotherapy and combination treatment for chronic depression Washington, DC: Symposium presented at the 108th annual meeting of the American Psychological Association; 2000Google Scholar

Fava, G.A.Tomba, E.New modalities of assessment and treatment planning in depression: the sequential approach. CNS Drugs 2010; 24: 453–465CrossRef Google Scholar PubMed

Daly, J.Willis, K.Small, R.Green, J.Welch, N.Kealy, M., et al.A hierarchy of evidence for assessing qualitative health research J Clin Epidemiol 2007; 60: 43–49CrossRef Google Scholar PubMed

NICE, Guideline development methods: Information for national collaborating centres and guideline developers London: National Institute for Clinical Excellence; 2005Google Scholar

Hirschfeld, R.M., et al.Does psychosocial functioning improve independent of depressive symptoms?. A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry 2002; 51(2): 123–133CrossRef Google Scholar PubMed

Zajecka, J., et al.Sexual function and satisfaction in the treatment of chronic major depression with nefazodone, psychotherapy, and their combination. J Clin Psychiatry 2002; 63(8): 709–716CrossRef Google Scholar PubMed

Nemeroff, C.B., et al.Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A 2003; 100(24): 14293–14296CrossRef Google Scholar PubMed

Gelenberg, A.J., et al.Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression. Biol Psychiatry 2003; 54(8): 806–817CrossRef Google Scholar PubMed

Manber, R., et al.The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression. Sleep 2003; 26(2): 130–136CrossRef Google Scholar PubMed

Klein, D.N., et al.Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol 2004; 72: 681–688CrossRef Google Scholar PubMed

Schatzberg, A.F., et al.Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Arch Gen Psychiatry 2005; 62(5): 513–520CrossRef Google Scholar PubMed

Arnow, B.A., et al.Dropouts versus completers among chronically depressed outpatients J Affect Disord 2007; 97(1–3):197–202CrossRef Google Scholar PubMed

Constantino, M.J., et al.Interpersonal styles of chronically depressed outpatients: Profiles and therapeutic change. Psychotherapy (Chic) 2008; 45(4): 491–506Google Scholar

Kocsis, J.H., et al.Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. J Clin Psychiatry 2009; 70(3): 354–361CrossRef Google Scholar PubMed

Stulz, N., et al.Differential effects of treatments for chronic depression: a latent growth model reanalysis. J Consult Clin Psychol 2010; 78(3): 409–419CrossRef Google Scholar PubMed

Constantino, M.J., et al.The relation between changes in patients’ interpersonal impact messages and outcome in treatment for chronic depression. J Consult Clin Psychol 2012; 80(3): 354–364 12CrossRef Google Scholar PubMed

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European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

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