In recent years more integrated therapies such as Schema Therapy (ST) and Short-term Psychodynamic Supportive Psychotherapy (SPSP) have been developed, focusing on depression in relation to inter- and intrapersonal patterns while taking into account etiologic long standing personality vulnerabilities. ĭespite the urgent need to extend our knowledge of treatment effect in the co-morbid group of patients with both depression and PD, until recently available empirically supported treatments (EST’s) have addressed either depression symptoms or personality pathology. In a study on the impact of dysthymic disorder on the outcome in PD patients however, a dysthymic disorder at baseline was related to the persistence of PD diagnoses at 2 years, especially for Borderline PD and Avoidant PD. This effect disappeared when controlled for general severity, suggesting that not the depressive disorder but high general severity at baseline is a negative predictor for success.
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In an randomized clinical trial (RCT) with mainly cluster-C patients, co-occurring depressions were associated with lower recovery rates at 3 year follow-up ( p = 0.01). Vice versa, research on the impact of a comorbid depressive disorder on recovery of PD is scarce. This review is based on pretreatment predictor analyses of outcomes in 34 studies with broad samples of depressed patients. A meta-analysis on the influence of PD on outcome of depression showed that treatment is two times less effective for depressed patients with PD than those without PD. Both depressive disorders and personality disorders are highly invalidating conditions and they represent a tremendous financial burden on society. This trial has been registered on July 20th 2016, Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR5941).ĭepressive disorders and personality disorders (PD) often co-occur. Understanding the processes that account for the therapeutic changes could help to gain insight in what works for whom. In addition, this study will contribute to the limited evidence base on treating patients with both depression and personality disorders.
Insight in the effect of treatment dosage for this patient group will contribute to both higher treatment effectiveness and lower costs. This trial will be the first to compare two psychotherapy dosages in patients with both depression and personality disorders. Costs will be collected from a societal perspective. Alongside the trial, an economic evaluation will be conducted. All patients are assessed at baseline and at 1, 2, 3, 6, 9–12 months (end of therapy) and at follow up (6 and 12 months after end of treatment). A priori postulated effect moderators and mediators will be collected as well. Changes in personality functioning and quality of life will be investigated as secondary outcomes. The primary clinical outcome measure will be depression severity and remission. They will be randomized over therapy dosage (25 vs 50 sessions in a year) and type of therapy (schema therapy vs short-term psychodynamic supportive psychotherapy). Patients will be recruited from a Dutch mental health care institute for personality disorders. In a mono-center pragmatic randomized controlled trial with a 2 × 2 factorial design, 200 patients with a depressive disorder and personality disorder(s) will be included. Secondary objectives will be addressed in order to find therapy-specific and non-specific mechanisms of change.
We expect the 50-session condition to be more effective in treating depression and maintaining the effect. This study aims to compare treatment outcome of 25 versus 50 individual therapy sessions in a year. Little is known about the effect of treatment dosage and type of psychotherapy for this specific co-morbid patient population, in terms of treatment-effect and cost-effectiveness. Patients with comorbid depression and personality disorders suffer from a heavy disease burden while tailored treatment options are limited, accounting for a high psychological and economic burden.
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