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Definition, Erkennung und Behandlung der therapieresistenten Depression

Year: 2026

Type: article

Abstract: Treatment-resistant depression (TRD) refers to a clinical state within the course of major depressive disorder in which no clinically meaningful symptom reduction or remission is achieved despite adequate dosing, sufficient treatment duration, and verified adherence to at least two antidepressant trials. Accurate identification of TRD requires a comprehensive clinical assessment, taking into account somatic and psychiatric comorbidities, treatment adherence, dosing, and duration of previous interventions. Management of TRD is complex and should be multimodal and individualized. Evidence-based pharmacological strategies include combination therapies and augmentation approaches, such as with lithium or atypical antipsychotics. Adjunctive non-pharmacological neuromodulatory interventions, including electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), are also available. Within the psychotherapeutic domain, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) represents a modality specifically developed for chronic forms of depression, integrating interpersonal and cognitive components within a unified treatment framework. Clinical studies have demonstrated initial, promising outcomes. To address existing gaps in care and improve treatment coordination, integrated care models are essential. The Integrated Care Depression (IV-D) program at the University Medical Center Hamburg-Eppendorf (UKE) exemplifies such an innovative approach: it combines multiprofessional, cross-sectoral treatment teams, evidence-based psychotherapy (including CBASP), and guideline-concordant pharmacotherapy within a continuous and coordinated care pathway. Such an integrative approach is pivotal to mitigating the substantial disease burden, risk of chronicity, and functional impairment associated with TRD. Integrated care models provide an evidence-based framework to substantially improve continuity of care, treatment quality, long-term outcomes, and quality of life in patients with TRD.

Source: Psychopharmakotherapie

DOI: 10.52778/ppt20260002