Department of Psychiatry, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
Adv Exp Med Biol. 2024;1456:257-271. doi: 10.1007/978-981-97-4402-2_13.
Many clinicians choose psychoanalytic psychotherapy or supportive psychotherapy as the primary method of treating depression with or without antidepressant medications. Despite new antidepressants, 20% or more patients showed inadequate responses to the medications, and remained in chronic courses, known as "treatment-resistant depression (TRD)."In this chapter, we described (1) the reasons for psychotherapy in treating TRD from the perspectives of the hazard of polypharmacy, resistance, and neural mechanisms. (2) Next, we focused on the importance of assessment with two clinical vignettes and the original modality of psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy in brief. (3) Finally, we described specific considerations in undertaking psychotherapy for TRD patients in terms of transference, countertransference, and resistance. In addition, the efficacy of psychoanalytic psychotherapy in childhood, adolescent, and late-life depression has been depicted in this paper.
许多临床医生选择精神分析疗法或支持性心理疗法作为治疗抑郁症的主要方法，无论是否使用抗抑郁药物。尽管有新的抗抑郁药，但仍有 20%或更多的患者对药物反应不佳，且仍处于慢性病程，即所谓的“治疗抵抗性抑郁症（TRD）”。在这一章中，我们从药物滥用的危险、耐药性和神经机制的角度描述了（1）精神疗法治疗 TRD 的原因；（2）接下来，我们重点介绍了使用两个临床案例和精神分析的原始模式，即精神分析疗法和支持性心理疗法进行评估的重要性；（3）最后，我们描述了在对 TRD 患者进行心理治疗时，在移情、反移情和阻抗方面需要考虑的具体问题。此外，本文还描述了精神分析疗法在儿童、青少年和老年抑郁症中的疗效。
