A terapia cognitivo-comportamental em grupo no tratamento do transtorno depressivo maior

Abstract

Major Depressive Disorder (MDD) is a psychopathology whose prevalence grows significantly with each generation, today affects more than 320 million people and is predicted that by 2030 it will be the first disabling cause for work. To elucidate the neurobiology underlying MDD is useful to understand this disorder, and is a service to the advancement of clinical practice focused on its identification and treatment. In this context, there are psychophysiological parameters with potential to be biomarkers of MDD, including cortisol and the sleep quality. Likewise, it is understood that, besides depressive symptoms, other psychological aspects are linked to the presence and course of MDD, being anxiety and self-esteem some of the main ones. Thus, this study, an open-label trial, aimed evaluating before and after monotherapy treatment using group Cognitive Behavioral Therapy (gCBT), cortisol (plasma and salivary) levels, anxious symptoms, selfesteem levels and sleep quality in depressed patients (n = 20; women n = 11), specifically college students. Prior to treatment, patients showed higher plasma cortisol levels than their healthy peers, the control group (n = 25; women n = 13), and higher salivary cortisol response on awakening and poor sleep quality. Patients responded to the intervention with decreased of depressive symptoms, and 55% of them achieved remission. In addition, there was a reduction in anxious symptoms, increased of self-esteem and improved sleep quality; however, cortisol levels remained without significant variations. Still, it was noticed that self-esteem had a mediating effect and that cortisol had a moderating effect on the symptoms of depression, due to the remission of MDD. In view of these data, the efficacy of gCBT monotherapy in the treatment of patients with mild and moderate levels of MDD was observed, which surpassed remission rates of clinical trials with psychotherapy, pharmacotherapy, and combined use of both. Therefore, it is understood be relevant additional studies that investigate the gCBT and psychophysiological biomarkers in order to contribute to the solidification of precision psychiatry.