Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications

Schramm, Elisabeth; Klein, Daniel N.; Elsaeßer, Moritz; Furukawa, Toshi A; Domschke, Katharina

doi:10.1016/s2215-0366(20)30099-7

Cited by 136 publications

(127 citation statements)

References 117 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may support a relationship between dysthymia and treatment resistance, 30 and consolidates the importance of adequately treating this group in the early stages of their condition. 31 It is noteworthy that 36% of the sample's current episodes were not treated pharmacologically for 2 years or more following the onset of a depressive episode. Around half the cohort did receive an adequate course of psychological therapy at some point within the 2-year period.…”

Section: Discussionmentioning

confidence: 99%

A retrospective examination of care pathways in individuals with treatment-resistant depression

et al. 2021

View full text Add to dashboard Cite

Background Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear. Aims To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK. Method Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced. Results Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment. Conclusions There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.

show abstract

Section: Discussionmentioning

confidence: 99%

A retrospective examination of care pathways in individuals with treatment-resistant depression

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Findings suggest that about a third of all depressed patients develop a chronic form of depression (3,5,6). Compared to non-chronic forms of depression, PDD patients tend to have a significantly earlier onset and higher levels of treatment resistance (1,2,5).…”

Section: Introductionmentioning

confidence: 97%

“…Persistent depressive disorder (PDD) is a highly debilitating psychological condition characterized by interpersonal difficulties and a high rate of comorbidities (1)(2)(3). PDD is defined by a duration of depressive symptoms for a minimum of 2 years and ranging in severity from dysthymia to chronic major depression [according to DSM-5, (4)].…”

Section: Introductionmentioning

confidence: 99%

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

et al. 2021

View full text Add to dashboard Cite

Introduction: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program.Method: Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed.Results: Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment.Discussion: BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.

show abstract

“…Compared to non-chronic forms of depression, pharmacotherapy and psychotherapy are less effective in patients with persistent depressive disorder [PDD, e.g., (2,3)]. This may be due to specific features of PDD that impede treatment success, such as higher comorbidity rates and more avoidant, submissive and hostile interpersonal behavior (4). These risk factors are assumed to have their roots in childhood and require specific interventions.…”

Section: Introductionmentioning

confidence: 99%

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

et al. 2021

View full text Add to dashboard Cite

Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality.Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors.Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders.Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.

show abstract

Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications

Cited by 136 publications

References 117 publications

A retrospective examination of care pathways in individuals with treatment-resistant depression

A retrospective examination of care pathways in individuals with treatment-resistant depression

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

Contact Info

Product

Resources

About