title: European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe.
abstract: OBJECTIVE
  Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.
  
  
  METHODS
  We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.
  
  
  RESULTS
  We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.
  
  
  CONCLUSIONS
  The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.
  
  
  CONCLUSIONS
  Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
authors: Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors: A
authors: A
authors: Jobst
authors: Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany.
authors: E-L
authors: EL
authors: Brakemeier
authors: Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria.
authors: A
authors: A
authors: Buchheim
authors: Institute of Psychology, University of Bern, Bern, Switzerland.
authors: F
authors: F
authors: Caspar
authors: Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
authors: P
authors: P
authors: Cuijpers
authors: Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: K P
authors: KP
authors: Ebmeier
authors: Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors: P
authors: P
authors: Falkai
authors: University Medical Centre, St. Radboud, Nijmegen, The Netherlands.
authors: R
authors: R
authors: Jan van der Gaag
authors: Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
authors: W
authors: W
authors: Gaebel
authors: Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany.
authors: S
authors: S
authors: Herpertz
authors: Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary.
authors: T
authors: T
authors: Kurimay
authors: Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors: L
authors: L
authors: Sabaß
authors: Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany.
authors: K
authors: K
authors: Schnell
authors: Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany.
authors: E
authors: E
authors: Schramm
authors: Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: C
authors: C
authors: Torrent
authors: National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
authors: D
authors: D
authors: Wasserman
authors: Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands.
authors: J
authors: J
authors: Wiersma
authors: Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany. Electronic address: padberg@med.uni-muenchen.de.
authors: F
authors: F
authors: Padberg
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D003863:Depression; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005060:Europe; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*
chemical_list: D000928:Antidepressive Agents
keywords: Affective disorders; Chronic depression; Persistent depressive disorder; Psychotherapy; Trauma