Visual Universitätsmedizin Mainz

Outpatient Clinic for Affective Disorders

Heads

Prof. Dr. K. Lieb, MD

Prof. W. Dr. Kelsch, MD

Dr. F. Müller-Dahlhaus, MD

M. Junginger, MD

Contact

Tel. 06131 17-7340

 ambulanz.psychiatrie@unimedizin-mainz.de

Treatment Resistent Depression

The specialized outpatient clinic serves to diagnose and plan outpatient or inpatient therapy for patients with treatment resistent depression.

In Germany, about 4 million people suffer from depression. Worldwide, depression is the most common cause of years of life lived with disability. In industrialized countries, no other disease causes more years of healthy life to be lost than depression. For those affected, depression leads to considerable suffering and often to incapacity for work and early retirement. This great clinical significance is offset by a considerable diagnostic and therapeutic deficit. One important reason for this is the fact that depression can manifest itself in very different ways. Patients with depression often initially complain of physical complaints for which, however, no physical causes can then be found. Other symptoms, such as depressed mood, reduced drive, concentration problems, negative thoughts about the future, feelings of guilt and thoughts of weariness about life, are often only detected during a detailed examination. During the examination by specialized physicians, the existing complaints can be identified as depression and differentiated from other illnesses. After the diagnosis has been made, a recommendation for a therapy strategy is worked out and agreed upon with the patient and the referring physician.  

The treatment offer is aimed at patients with treatment resistent depression (TRD), or physicians who treat patients with TRD and would like a second opinion on the diagnostic assessment or the therapy. If remission is not achieved by at least two adequate attempts at drug treatment, treatment-resistant depression (TRD) is suspected. When TRD is suspected, always rule out so-called "pseudotherapy resistance," in which the lack of improvement is due to causes other than failure of adequately administered antidepressant treatment. Important potential causes of pseudotherapy resistance include inadequate therapy, misdiagnosis, concomitant psychiatric illnesses, concomitant physical illnesses, and the use of medications that may promote and/or maintain depressive syndromes. A detailed and structured evaluation of the previous therapy strategy, the diagnosis and potential concomitant diseases is carried out to record these influencing factors. After the diagnosis has been made, a recommendation for a therapy strategy is developed and agreed upon with the patient and the referring physician.

Our depression outpatient clinic offers outpatients and referred patients a service for diagnosis and planning of outpatient or inpatient therapy for treatment-resistant depression with indication testing for neurostimulation procedures, as well as the opportunity to provide patients and their relatives with detailed information and advice about these procedures. Depending on the individual indication, repetitive transcranial magnetic stimulation (rTMS) or electroconvulsive therapy are used as neurostimulation procedures. Both methods show high efficacy and are well tolerated. Once the symptoms have improved, inpatient therapy is followed by outpatient maintenance therapy at longer intervals in order to maintain the improvement achieved. For certain indications, we also offer other neuromodulatory procedures such as ketamine therapy, which has been proven to be effective in studies, as part of a multimodal therapy Concept.  

Bipolar Disorders

The special outpatient clinic is open to patients with diagnosed bipolar disorder and medical colleagues who treat patients with therapy-resistant bipolar courses for a second opinion on the diagnostic assessment or the therapy. If a mental illness or bipolar disorder is suspected, a registered psychiatrist should be consulted first. Long-term treatment in the Bipolar Outpatient Clinic is possible within the framework of university tasks in research and teaching.

The special outpatient clinic for bipolar disorders is a joint project of the Department of Psychiatry and Psychotherapy at the University Medical Center Mainz (Director: Prof. Dr. Klaus Lieb), the University Outpatient Clinic for Psychotherapy at the University of Mainz (Director: Prof. Dr. Michèle Wessa) and the Department of Psychiatry, Psychotherapy and Psychosomatics at the University Hospital Frankfurt (Director: Prof. Dr. Andreas Reif).