How long should drug treatment of depression last?
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Antidepressive Agents↗
Biomedical subjects
Chiara Ruini
Publications and source records attributed to Chiara Ruini.
Development and characteristics of a well-being enhancing psychotherapeutic strategy: well-being therapy.
This article describes the main characteristics and technical features of a novel psychotherapeutic strategy, well-being therapy. This paper outlines the background of its development, the structure of well-being therapy, its key concepts and technical aspects. Well-being therapy is based on Ryff's multidimensional model of psychological well-being, encompassing six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations and self-acceptance. The goal of this therapy is improving the patients' levels of psychological well-being according to these dimensions, using cognitive-behavioral techniques. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive-behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological or psychotherapeutic treatments and in body image disturbances. The clinical studies supporting its efficacy are illustrated.
Humans↗
Cognitive behavior approach to loss of clinical effect during long-term antidepressant treatment: a pilot study.
OBJECTIVE: The aims of this investigation were to explore the feasibility of a cognitive behavior approach to loss of clinical effect during long-term antidepressant therapy and to compare it with dose increase. METHOD: Ten patients with recurrent depression who relapsed while taking antidepressant drugs were randomly assigned to dose increase and clinical management or to cognitive behavior therapy and maintenance of the antidepressant drug at the same dose. RESULTS: Four of five patients responded to a larger dose, but all had relapsed again on that dose by the 1-year follow-up. Four of five patients responded to cognitive behavior therapy, and only one relapsed during follow-up. CONCLUSIONS: The data suggest that application of a cognitive behavior therapy approach is feasible when there is a loss of clinical effects during long-term antidepressant treatment and may carry long-term benefits. The results need to be confirmed with large-scale controlled studies.
Antidepressive Agents↗
[Long-term treatment of depression: there is more than drugs].
Recent studies have emphasized the chronic nature of depressive disorder, and the need for endorsing the same treatment protocols used for other chronic disease, such as diabetes. But duration of treatment does not seem to affect long-term prognosis of patients with depression, once the drug is stopped. Despite treating depression effectively in the short-term, antidepressant drugs may worsen its course. Treatment of depression by pharmacological means is likely to leave residual symptoms in most patients. Such symptoms are important risk factors for relapse. In randomised controlled studies, cognitive behavioural treatment of residual symptoms significantly improved long-term outcome of recurrent depression. Indeed, depressive disorder has a chronic nature, but antidepressants are not the only possible treatment strategy. Cognitive-behavioral psychotherapy is an alternative, which is effective in engendering a complete and lasting recovery in patients with depression.
Depression↗
Management of recurrent depression in primary care.
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Adult↗
The relationship of psychological well-being to distress and personality.
BACKGROUND: The concept of psychological well-being has been neglected for a long time in scientific literature. Over the last decades, however, many psychometric instruments have been developed to measure it. The aim of the present study was to analyze the concept of psychological well-being and its relationship to distress and personality traits. It is clinically and empirically important to establish where the measures of well-being are located in relation to symptomatology indices and personality traits. METHODS: A sample of 450 subjects in the general population completed three self-rating scales for the assessment of symptomatology (Kellner's Symptom Questionnaire), psychological well-being (Ryff's Psychological Well-Being Scales, PWB), and personality traits (Cloninger's Tridimensional Personality Questionnaire). The assessment was repeated after 1 month. Pearson's coefficient was used to analyze PWB test-retest reliability and correlations between well-being, distress and personality indicators. Exploratory factor analysis was performed for both assessments. RESULTS: Test-retest Pearson's coefficients were satisfactory for all six PWB scales. Exploratory factor analyses showed a 4- or 5-factor structure, where well-being, distress and personality remained separated. PWB scales were negatively and significantly correlated with all symptom scales, but only with one personality dimension, TPQ Harm Avoidance. Mean-level differences by gender showed that in general women significantly presented with lower levels of well-being (except in Positive Relations) and higher levels of distress and personality disturbances. CONCLUSIONS: The results suggest that the relationship of well-being to distress and personality is complex. Psychological well-being could not be equated with the absence of symptomatology or with personality traits. PWB scales measure an attitude toward optimal functioning that is crucial for a comprehensive consideration of individuals in clinical settings.
Adolescent↗