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Themenschwerpunkt

Psychotherapie von Patienten mit Depression und Abhängigkeitserkrankung

Published Online:October 12, 2011https://doi.org/10.1024/0939-5911.a000140

Abstract

Fragestellung: Im Verlauf einer Suchterkrankung kommt es häufig zum Auftreten depressiver Störungen. Depressive Symptome, die auch nach Abschluss der Entzugsphase persistieren, erweisen sich als ein zentraler Prädiktor für einen Rückfall und sollten im Rahmen von Diagnostik und Therapie berücksichtigt werden. Methodik: In der vorliegenden Arbeit wurde eine systematische Literaturrecherche durchgeführt, um sowohl randomisierte Therapievergleichsstudien als auch weitere klinische Studien zu identifizieren, die die Effektivität einer integrativen Behandlung von Abhängigkeitserkrankungen und Depression untersuchen. Ergebnisse: Die Ergebnisse der wenigen identifizierten Untersuchungen zeigen, dass durch ein integratives Behandlungskonzept, bei dem sowohl die Suchterkrankung als auch depressive Störungen behandelt werden, eine Reduktion depressiver Symptome und eine Steigerung der Abstinenzquote erzielt wird. Schlussfolgerungen: Methodische Mängel der vorliegenden Untersuchungen bzw. die noch ausstehende Replikation von Befunden schränken jedoch gegenwärtig die vorliegenden positiven Ergebnisse zur integrierten Behandlung ein. Ferner gestaltet sich die Etablierung integrierter Behandlungsansätze aufgrund der nach wie vor zu beobachtenden Trennung zwischen Einrichtungen der Suchtkrankenhilfe und allgemein-psychiatrischen Einrichtungen schwierig.


Psychotherapeutic Treatment for Addiction and Comorbid Depression

Aim: The comorbidity of addictive disorders and depression is common. Several studies demonstrated that depressive symptoms which persist after withdrawal are significantly associated with relapse. Thus, diagnosis and therapy should focus on both diseases and integrative treatment approaches are necessary. Methods: In this paper we present the results of a systematic review of the literature to identify randomized control studies and other clinical studies investigating the effects of combined interventions for addictive disorders and depression. Data Sources were PubMed and ScienceDirect databases, using the keywords “psychotherapy” in conjunction with “substance dependence”, “depression” and “dual diagnosis”. Each keyword was diversified by multiple synonyms. Database records of the last 20 years were considered. In addition, German peer-reviewed journals not indexed in Medline were reviewed to identify further clinical trials. Results: The results of these analyses yielded ten clinical trials. Their results demonstrate the beneficial effects of integrative cognitive-behavioural treatment approaches with regard to a reduction of depressive symptoms as well as abstinence rates. Conclusions: Notwithstanding methodological shortcomings of present studies, there is evidence for the beneficial effects of an integrative treatment approach for addiction and depression. However, the implementation of such integrative treatment approaches in Germany is far from optimal, probably due to the segregation of addiction services and mental health services.

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