Psicoterapia psicodinâmica e tratamento biológico com fluoxetina: comparação de resposta cognitiva em pacientes deprimidos

Abstract

RESUMO -A depressão é uma doença grave, com repercussões importantes no humor e na cognição. Tratamentos farmacológicos e/ou psicoterápicos estão comumente indicados. O presente estudo objetivou avaliar e comparar a cognição de pacientes deprimidos antes e após 12 meses de tratamento com fluoxetina ou psicoterapia psicodinâmica. Cento e oitenta pacientes foram divididos em dois grupos, e avaliados por meio da WAIS-III. Os resultados mostraram uma melhora significativa em diferentes subtestes da WAIS-III. A MANOVA indicou que há uma diferença significativa entre os grupos nas pontuações médias obtidas na reavaliação 12 meses após o início dos tratamentos. Os resultados sugerem que a psicoterapia psicodinâmica e a terapia com fluoxetina agem de forma diferente na cognição de pacientes deprimidos.Palavras-chave: psicoterapia psicodinâmica, fluoxetina, cognição, depressão Psychodynamic Psychotherapy and Biological Treatment with Fluoxetine: Comparison of Cognitive Response in Depressed PatientsABSTRACT -Depression is a serious illness with an important impact on humor and cognition. Pharmacological treatments and/or psychotherapy are commonly indicated. The present study aimed to compare cognition in adult patients diagnosed with depression before and after 12 months of treatment with fluoxetine or psychodynamic psychotherapy. One hundred and eighty depressed patients were divided into two treatment groups, and cognitively assessed with the WAIS-III. Results showed a significant improvement in different subtests of WAIS-III. MANOVA indicated that there is a significant difference between groups in the mean scores of the post-treatment assessment. The results suggest that psychodynamic psychotherapy and fluoxetine act differently on cognition of depressed patients.

Predictors of response in the treatment of moderate depression

“…Three studies that used the WAIS-III in a long-term psychoanalytic psychotherapy context reported only testretest changes in patients and did not attempt to find predictive outcome variables. 16,21,33 In the present study, the sociodemographic domain did not result in statistically significant predictive variables (i.e., age, sex, marital status, and level of education). Some studies, however, identified age as a predictor of slower response to treatment, 7,26 while others found no association between age and treatment outcome.…”

“…Although a number of studies on the association between cognitive variables and depressive symptoms have been published, 15,16 we found no studies using neurocognitive markers (obtained from WAIS-III) as predictive variables when comparing different treatments. Three studies that used the WAIS-III in a long-term psychoanalytic psychotherapy context reported only testretest changes in patients and did not attempt to find predictive outcome variables.…”

“…25 The BDI measures severity of depression and classifies results as minimal (score, 0-11), mild (score, [12][13][14][15][16][17][18][19], moderate (score, 20-35), or severe (score, 36-63).…”

“…10 Until recently, only minor attention had been given to neurocognitive performance as a moderator of treatment outcome in studies on depression, 14 despite studies on the association between cognitive variables and depressive symptoms. 15,16 Some authors have described the relevance of neurocognitive variables for predicting symptomatic improvement. 17 For instance, neurocognitive function at baseline was not predictive of symptom improvement in depression.…”