Chronic depression

Abstract

Chronic depression is a disorder defined by its symptom severity and its course. There are several manifestations of this problem, but most classification systems differentiate these according to whether symptoms meet criteria for major depression or other forms of depression, and/or whether the symptoms persist at a syndromal or subsyndromal level. Using these parameters, there are four recognized subtypes: (1) chronic major depressive disorder, (2) dysthymic disorder, (3) dysthymic disorder with major depressive disorder ("double depression"), and (4) major depressive disorder with poor interepisodic recovery (i.e., incomplete remission). According to these definitions it is estimated that the prevalence of chronic depressions is 3-6% of the general population, but probably affects about 30% of depressed patients following acute treatment, suggesting that a significant number of patients do not fully respond to available treatments, and, in particular, to the most common treatment, namely, antidepressant medication (Cornwall & Scott, 1997; Paykel et al., 1995). In addition to increasing risk for future relapse (e.g., see Judd, 1997), persistent depressive symptoms are an important clinical target in their own right, because they produce substantial distress and suffering, are frequently drug refractory, are associated with a history of recurrent depression, and significantly impair work and social performance (Cornwall & Scott, 1997; Judd, 1997; Paykel et al., 1995). In this chapter, we provide an overview of conceptualization, assessment, and cognitive therapy (CT) for chronic major depression, dysthymia, and their combination; CT for partially remitted depression is described by Fava and Fabbri, Chapter 5, this volume (see record 2008-03297-005). (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)