Paetow Rebecca, Frodl Thomas
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinik Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Nervenarzt. 2025 Jan;96(1):37-45. doi: 10.1007/s00115-024-01756-9. Epub 2024 Oct 14.
The definition of long-term courses of depression is heterogeneous. Chronic and treatment-resistant courses, in particular, represent a high-cost factor and greatly reduce the quality of life. Based on the pharmacotherapeutic treatment-resistant depression (TRD), more and more systemic approaches are becoming important.
This narrative review provides an overview of the long-term course of depressive disorders, including various definitions and influencing factors. In addition, an overview of biomarker research on treatment response with a focus on neuroimaging is presented.
A selective literature search was conducted in PubMed and Google Scholar for a narrative review. Particular attention was given to larger cohort studies, systematic reviews, meta-analyses and studies on the prediction of treatment response.
Chronic and treatment-resistant courses mean a relevant reduction in the quality of life and increased health risks. The assessment of treatment response is a definitional challenge: An alternative to TRD is the systemically oriented difficult to treat depression (DTD). The focus is thus moving away from symptom reduction towards controlling the level of functioning. Biomarker research for treatment response offers potential but currently mainly serves to gain theoretical knowledge.
Recording the long-term course of depressive illnesses is important, but also complex. Clinical interventions should therefore include a continuous monitoring and the focus on maintaining the quality of life.
抑郁症长期病程的定义并不统一。尤其是慢性和难治性病程，是一个高成本因素，会大大降低生活质量。基于药物治疗难治性抑郁症（TRD），越来越多的系统性方法正变得重要起来。
本叙述性综述概述了抑郁症的长期病程，包括各种定义和影响因素。此外，还介绍了以神经影像学为重点的治疗反应生物标志物研究综述。
在PubMed和谷歌学术上进行了选择性文献检索以撰写叙述性综述。特别关注了大型队列研究、系统评价、荟萃分析以及治疗反应预测研究。
慢性和难治性病程意味着生活质量的显著下降和健康风险的增加。治疗反应的评估是一个定义上的挑战：TRD的替代方案是以系统为导向的难治性抑郁症（DTD）。因此，重点正从症状减轻转向功能水平的控制。治疗反应的生物标志物研究具有潜力，但目前主要用于获取理论知识。
记录抑郁症的长期病程很重要，但也很复杂。因此，临床干预应包括持续监测并注重维持生活质量。
