The issues of recovery and remission are getting increasing attention in depression research, particularly after the publication of the STAR*D results. The paper analyzes some issues which may hinder effective treatment of major depressive disorders: the inadequacies of a cross-sectional DSM assessment without clinical differentiation of the extent, development and seriousness of the disturbances (staging); over-emphasis on and prolongation of drug treatment, without paying attention to problems related to tolerance; neglect of the active role of the patient in achieving recovery, with the integration of psychotherapeutic strategies in a sequential model. If we are able to remove the conceptual obstacles which obstruct our view of depression and are able to correctly identify the therapeutic factors underlying treatment response we may then become aware of a different scenario in mood disorders and be able to develop therapeutic strategies of enduring quality.
The issues of recovery and remission are getting increasing attention in depression research, particularly after the publication of the STAR*D results. The paper analyzes some issues which may hinder effective treatment of major depressive disorders: the inadequacies of a cross-sectional DSM assessment without clinical differentiation of the extent, development and seriousness of the disturbances (staging); over-emphasis on and prolongation of drug treatment, without paying attention to problems related to tolerance; neglect of the active role of the patient in achieving recovery, with the integration of psychotherapeutic strategies in a sequential model. If we are able to remove the conceptual obstacles which obstruct our view of depression and are able to correctly identify the therapeutic factors underlying treatment response we may then become aware of a different scenario in mood disorders and be able to develop therapeutic strategies of enduring quality
Il conseguimento della guarigione dai sintomi nei pazienti depressi è al centro dell’attenzione della ricerca in ambito clinico, in particolare in seguito alla pubblicazione dei risultati relativi allo studio multicentrico americano STAR*D. In questo articolo saranno analizzati gli aspetti problematici che hanno contribuito a ridurre l’efficacia dei trattamenti usati nella cura della depressione maggiore. Primo fra tutti l’inadeguatezza di un processo di valutazione basato su un approccio trasversale categoriale proprio del DSM, che non prevede la valutazione differenziata del disturbo in base all’entità, al decorso e alla gravità dei sintomi (ciò che viene definito stadiazione della malattia). Un secondo aspetto riguarda l’enfasi data all’uso prolungato nel tempo del trattamento farmacologico, sottovalutandone le problematiche associate quali l’insorgenza dei fenomeni di tolleranza . Un ulteriore ostacolo analizzato riguarda la scarsa considerazione data al ruolo attivo del paziente nel processo di guarigione, con l’integrazione di strategie psicoterapeutiche fornite in un modello sequenziale. Eliminare gli ostacoli che hanno offuscato la concettualizzazione della depressione e la corretta identificazione dei suoi fattori terapeutici renderà possibile il manifestarsi di un diverso scenario nell’approccio ai disturbi dell’umore con il conseguente sviluppo di strategie terapeutiche in grado di produrre risultati duraturi.
Elena Tomba, Silvana Grandi, Giovanni A. Fava (2009). I fattori terapeutici nella depressione: nuove strategie = Therapeutic factors in depression: new strategies. RIVISTA DI PSICHIATRIA, 44(2), 95-101 [10.1708/420.4979].
I fattori terapeutici nella depressione: nuove strategie = Therapeutic factors in depression: new strategies
TOMBA, ELENA;GRANDI, SILVANA;FAVA, GIOVANNI ANDREA
2009
Abstract
The issues of recovery and remission are getting increasing attention in depression research, particularly after the publication of the STAR*D results. The paper analyzes some issues which may hinder effective treatment of major depressive disorders: the inadequacies of a cross-sectional DSM assessment without clinical differentiation of the extent, development and seriousness of the disturbances (staging); over-emphasis on and prolongation of drug treatment, without paying attention to problems related to tolerance; neglect of the active role of the patient in achieving recovery, with the integration of psychotherapeutic strategies in a sequential model. If we are able to remove the conceptual obstacles which obstruct our view of depression and are able to correctly identify the therapeutic factors underlying treatment response we may then become aware of a different scenario in mood disorders and be able to develop therapeutic strategies of enduring qualityI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.