The concept of recovery in major depression

Department of Psychology PSI, University of Bologna, Bolonia, Emilia-Romagna, Italy
Psychological Medicine (Impact Factor: 5.94). 04/2007; 37(3):307-17. DOI: 10.1017/S0033291706008981
Source: PubMed


There is increasing literature on the unsatisfactory degree of remission that current therapeutic strategies yield in unipolar depression. The aims of this review were to survey the available literature on residual symptoms of depression, to introduce new targets for therapy and to outline a more stringent definition of recovery.
Studies were identified by using MEDLINE (English language articles published from 1967 to June 2006; keywords: recovery, remission, residual symptoms, sequential treatment, drugs and psychotherapy, related to depressive disorder and depression) and a manual search of the literature and Index Medicus for the years 1960-2006.
Most patients report residual symptoms despite apparently successful treatment. Residual symptoms upon remission have a strong prognostic value. There appears to be a relationship between residual and prodromal symptomatology. The concept of recovery should involve psychological well-being.
Appraisal of subclinical symptomatology in depression has important implications for pathophysiological models of disease and relapse prevention. New therapeutic strategies for improving the level of remission, such as treatment on residual symptoms that progress to become prodromes of relapse, may yield more lasting benefits.

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    • "Thus, it seems important to identify low mental well-being to avoid lingering absence and, in the longer-term perspective, disability pensions. In psychiatric research, it has been suggested that well-being is an important complement to diagnostic procedures of symptoms because it has higher relevance to an individual’s quality of life, and it may better capture recovery or subclinical symptoms [35,38,39]. "
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    • "In the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (Sandell et al., 2000), the development of social functioning was virtually the same whether a patient had been in psychoanalysis or psychotherapy; mean improvement was almost exactly equal in both groups, and within-group effect sizes were small for both groups. Personality functioning is hypothesized to play a contributing role in the development of depression (Akiskal, Hirschfeld, & Yerevanian, 1983; Kendler, Gatz, Gardner , & Pedersen, 2006; Krueger, 2005; Morey et al., 2007), and impairment in personality functioning, beyond its significance for social adjustment and life satisfaction, has been shown to predispose individuals for symptom persistence, relapse, and recurrence (Fava et al., 2007). Therefore, improvement in personality functioning may function as a mediator for the stability of symptom change, and Grande and colleagues (2009) indeed found that personality change at post-treatment was a predictor of patient self-reported symptom change at 3-year follow-up. "
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    ABSTRACT: The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and threeyear follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.
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    • "Together with the investigation of long-term stability, the research question of how and why treatments achieve stable results became central (Kazdin 2007). Meanwhile, empirical evidence has accumulated that impaired personality structures like inadequate personality functioning or distorted self-schemata (Beshai et al. 2011) may predispose patients to relapse and recurrence (Fava et al. 2007). Therefore, outcome research increasingly targets personality structures but still empirical findings are only tentative (e.g., which treatment models enable patients to change maladaptive personality structures). "
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    No preview · Article · Aug 2012 · Zeitschrift fur Psychosomatische Medizin und Psychotherapie
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