Samenvatting

G. D. VAN RIJSBERGEN & C.L.H. BOCKTING

MONITORING FOR RELAPSE AFTER REMISSION FROM RECURRENT DEPRESSION. WILL FEELINGS DO?

Depression is a highly recurrent disorder. International guidelines recommend systematic life-long monitoring of high risk patients. This raises the question how to monitor remitted patients in a feasible and acceptable way. Experiencing sad mood after remission has been related to relapse in depression. Therefore we examined whether a Visual Analogue Scale (VAS) that assessed sad mood was able to predict relapse within an RCT. Remitted patients with higher scores on the VAS relapsed faster over 5.5 years. Additionally, a VAS was able to accurately detect current depression (SCID-I as gold standard), although the number of false positives was high which requires follow-up of positive screens by an additional instrument (questionnaire or clinical interview). More studies need to be conducted before the VAS can be implemented as a monitoring tool in clinical practice.

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Depressie is een recidiverende aandoening met hoge kans op terugval. Internationale richtlijnen adviseren om patiënten die zijn hersteld van recidiverende depressie levenslang te monitoren op terugval. Kan dat wel? En zo ja, hoe moet dat dan? Momenteel wordt onderzoek gedaan naar het gebruik van een simpele Visueel Analoog Schaal waarop patiënten hun stemming kunnen aangeven. Kan deze schaal uitkomst bieden als monitoring instrument, vragen Gerard van Rijsbergen en Claudi Bockting zich af.

De unipolaire depressieve stoornis (verder in dit artikel ‘depressie’ genoemd) is één van de meest voorkomende psychiatrische aandoeningen in Nederland. Geschat wordt dat één op de zes mensen in Nederland ooit in zijn of haar leven een depressie krijgt (De Graaf et al., 2012)14. Depressie brengt een enorme ziektelast met zich mee, die op de eerste plaats bestaat uit lijdensdruk voor de patiënt en zijn of haar omgeving, maar daarnaast ook uit bijvoorbeeld kosten voor de gezondheidszorg en uit verlies van arbeid. Deze hoge mate van ziektelast wordt deels bepaald door het recidiverende karakter van de aandoening. In tegenstelling tot wat mensen soms denken, is depressie vaak geen eenmalige aandoening die, na behandeling, voorgoed verbannen is uit het leven van de getroffen persoon. De kans op een terugval in depressie neemt toe met het aantal episodes dat een patiënt heeft doorgemaakt, en elke episode blijkt de kans op een volgende depressieve episode met 16% te doen toenemen (Solomon et al., 2000)28. Schattingen rondom het percentage terugval na herstel van een episode lopen uiteen. Longitudinale studies laten zien…

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