Per Bech and Wolfgang Rutz: The Story of the International Committee for the Prevention and Treatment of Depression
The International Committee for the Prevention and Treatment of Depression (PTD) was founded by Paul Kielholz in 1975. The background for the PTD was that psychiatrists worldwide felt that they were unable to cope with the increasing number of depressed patients to treat with the new antidepressants. It was the goal of the PTD concept to collaborate with the general practitioners through courses, seminars, and discussion evenings, but also to establish a telephone service for the family doctors to acquire prompt information and to perform research on depression with particular reference to conditions prevailing in the everyday practice.
Paul Kielholz was, from 1975 to 1990, chairman of the PTD International Committee which included such members as Pierre Pichot (Paris), Costas Stefanis (Athens), Hanns Hippius (Munich), Giovanni Cassano (Pisa), Carlos Ballus (Barcelona), Desmond Kelly (London), Ole Rafaelsen (Copenhagen) and Gunnar Holmberg (Stockholm).
As chairman of the British National PTD Committee, Desmond Kelly edited a book entitled “A practical handbook for the treatment of depression” (Kelly and Frances 1987).
This book is the most impressive PTD publication internationally with 30 expert contributors covering important information for the family doctors treating clinically depressed patients.
Costas Stefanis became chairman of the International PTD committee after Paul Kielholz and Per Bech became secretary. Stefanis made an attempt to integrate PTD with the World Psychiatric Association (WPA), but without success. One of the most important PTD research projects was the Gotland Project on Education and Collaboration on Depression chaired by the National PTD committee in Sweden (Jan Wålinder, Lars von Knorring and Wolfgang Rutz). The study was scientifically evaluated and became later internationally known as the “Gotland Study” under the leadership of Wolfgang Rutz.
The educational program, carried out under the patronage of Queen Silvia of Sweden, was offered twice for two days during a two-year period to all General Practitioners on Gotland. It focussed on an integrated approach to the early therapy, treatment and monitoring of depression and led to a dramatic decrease in depression related morbidity and mortality on the island (Rutz et al 1992). Especially noted were the rates of suicide that, before the educational intervention, were the highest in Sweden; these dropped down to the lowest figures, primarily in females. The reasons for not reaching a similar effect on male suicidality became apparent in a consecutive autopsy study that showed that suicidal males were seldom reached by the GP’s improved capacity and were caused by their atypical depressive phenomenology, as well as their non- or inadequate help-seeking behaviour, leading to their suicide without contact with the medical system (Rutz 2001).
The autopsy study lead to the definition of a “typically untypical male suicidal and depressive syndrome,” presented and evaluated as “Gotland Male Depression Scale – GMDS.” The GMDS was translated into more than 10 languages and showed to be well suited as a screening and diagnostical tool for diagnosing male depressive reactions with their components of destructive acting out, violence, alexithymic abuse and regression. In an educational follow up, the GMDS scale was employed and lead to the now even lowest male suicide figures registered on Gotland.
The Gotland Study became the recommended example of good practice in the WHO World Report on Mental Health, as well as the EUs Green Book and Pact on Mental Health. Thus, today the Gotland study has become a model for successful activities in suicide prevention through education, used under the auspices of the EU and the WHO in and outside of Europe in a number of national suicide prevention programs. Here depression, suicidality, aggression and (self-) destructive behaviour in the aftermath of immigration and refugee flows have again increased the importance and interest for topics of posttraumatic depression, as well as male depressive and regressive symptomatology.
Finally, other PTD activities during the last decades, under the chairmanship of Jan Wålinder, consist of education to psychiatric teams and mental health workers, as well as having an advisory function affiliated to the Universities of Lund, Uppsala, Örebro, Stockholm Karolinska Institutet and the University of Coburg/Germany. Of the PTD members, Jan Wålinder, our last chairman, Börje Wisted and Göran Eberhardt have died and the other members are retired. Wolfgang Rutz’s position, from 1998 to 2005, as the director of the European mental health department at the World Health Organisation has - partly in collaboration with Costas Stefanis and Per Bech - provided further influence and sustainability to the PTD Group’s activities hitherto.
In October 2016, Costas Stefanis passed away. We had been in contact with him about the closing of PTD and it was Costas’ last decision that we, in the name of Paul Kielholz, should transfer the PTD account to Collegium Internationale Neuro-Psychopharmacologicum (CINP). It is in the spirit of Paul Kielholz, who was a great ambassador of positive psychiatry, that we are now under the umbrella Positive Psychiatry (Jeste and Palmer 2015) and are donating the PTD account to CINP.
Jeste DV, Palmer BW, editors. Positive Psychiatry. A Clinical Handbook.
Washington: American Psychiatric Publishing, 2015. Kelly D, Frances R, editors. Treatment of Depression. London: Parthenon Publishing Group; 1987.
Rutz W. Preventing suicide and premature death by education and treatment.
J Affect Disord. 2001; 62:123-129.
Rutz W, Carlsson P, von Knorring L, Wålinder J. Cost-benefit analysis of an
educational program for general practitioners by the Swedish Committee for
the Prevention and Treatment of Depression. Acta Psychiatr Scand
November 30, 2017