DÄ internationalArchive18/2009Treatment of Depressive Disorders: The Value of Psychotherapeutic Methods in Treating Depression

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Treatment of Depressive Disorders: The Value of Psychotherapeutic Methods in Treating Depression

Dtsch Arztebl Int 2009; 106(18): 319. DOI: 10.3238/arztebl.2009.0319a

Waldmann, V

LNSLNS The CME article is biased in its unilateral evaluation in favor of pharmacological therapy with antidepressants and at the expense of psychotherapeutic therapeutic options. The stipulated division of therapy into phases thus implies a psychopharmacological approach; the authors cite a publication that is 35 years old and published by the pharmaceutical industry. The treatment setting that is discussed subsequently does include basic therapy provided by the general practitioner, as well as "psychiatric referral, " but up to this point, no psychological or medical psychotherapists or psychosomatic specialists are mentioned. What follows is somewhat blurred, when an algorithm of whatever preference would be helpful here: in mild and moderate depressive disorders—the vast majority—the authors prefer monotherapy, whether as pharmacotherapy or psychotherapy; the differential indication in the authors' view being availability of service provision and patient preference. Even psychosomatically oriented compendia (1) offer more helpful, more objective approaches. The decisive effective factor of specific psychotherapy (which includes both psychoanalytical and cognitive behavior therapies)—the therapeutic relationship (2)—is stripped of its value and misunderstood in its essence if the authors stipulate the "conversation with an empathic and understanding physician", sensing "the physician's acceptance of his or her worries and fears and should feel relieved as a result of the therapeutic interview" as the basis of depression treatment beyond specific psychotherapy. Outside the setting of specific psychotherapy these are platitudes that every patient would desire and appreciate.

A more honest title of the article would have restricted itself to pharmacological therapy, as the authors themselves do in their "algorithm-based stepwise treatment regimen" for depressive disorders; psychotherapy does not exist here. The opportunity was sadly missed, to provide a summarizing overview of psychotherapeutic approaches in depressive disorders and of their value and differential indications (as done in locations that are not always easily accessible[3]).
DOI: 10.3238/arztebl.2009.0319a


PD Dr. med. Volker Waldmann
Belgradstr. 5
80796 München, Germany
vwaldmann@web.de

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Janssen P, Joraschky P, Tress W: Leitfaden Psychosomatische Medizin und Psychotherapie. Köln: Deutscher Ärzte-Verlag 2006.
2.
Hiller W, Leibing E, Leichsenring F, Sulz S: Lehrbuch der Psychotherapie, München: CIP-Medien 2004.
3.
Faust V: Psychische Störungen heute. Landsberg: Ecomed, ständig aktualisierte Loseblattsammlung 2002.
4.
Bschor T, Adli M: Treatment of depressive disorders. [Therapie depressiver Erkrankungen.] Dtsch Arztebl Int 2008; 105(45): 782–92.
1. Janssen P, Joraschky P, Tress W: Leitfaden Psychosomatische Medizin und Psychotherapie. Köln: Deutscher Ärzte-Verlag 2006.
2. Hiller W, Leibing E, Leichsenring F, Sulz S: Lehrbuch der Psychotherapie, München: CIP-Medien 2004.
3. Faust V: Psychische Störungen heute. Landsberg: Ecomed, ständig aktualisierte Loseblattsammlung 2002.
4. Bschor T, Adli M: Treatment of depressive disorders. [Therapie depressiver Erkrankungen.] Dtsch Arztebl Int 2008; 105(45): 782–92.

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