Treatability of Chronic Depression
Jul 15, 2012
In an unsurprising conjunction, my most recent (automated) advisory of new research from PubMed -- [LINK] -- reports of new research showing:
- in-hospital psychological treatments added significant (but not major) benefit to usual care and structured pharmacotherapy -- Cuijpers et al, Clinical Psychology Review (2011) [LINK] -- this was a meta-analysis and did not specifically address etiology of depression -- in fact, the meta-analysis found generally limited, and poor quality, studies existed)
- in a local study, Douglas and Porter, Psychiatry Research (2012) -- [LINK] -- treatment non-responders reported significantly more severe trauma than treatment responders and healthy controls , suggesting that the experience of childhood trauma in those hospitalised with depression can be detrimental to treatment success.
Clearly,
- patients admitted to hospital when suffering from depression should be assessed for history of childhood trauma, and if found to still be suffering such effects (and this decision should be based on more than the clinician's impressions -- D'Andrea et al 2012 [LINK])
- should receive treatment additional to "usual care" and structured pharmacotherapy, but (as noted in a previous post -- May 5, 2012 see -- [LINK]), such care should be agreed upon in a collaborative relationship with the patient, and the care provided with the patient's agreement and active cooperation -- this may need to be based on initial psychoeducational intervention (Feeny et al, 2009 -- [LINK],, Jaeger et al (2009 -- [LINK]
A final observation can also be made -- we are moving more and more towards having evidence-based standards of care for adults suffering childhood trauma-related depressive disorders.