The Biology of Chronic Depression

Abstract

A dramatic shift has occurred in the conceptualization of chronic depressions by clinical psychiatrists over the past decade. Prior to 1980 chronic depressions, particularly those with onset at an early age, were usually regarded as “personality disorders” or “neuroses” and were either treated by psychotherapy or left untreated altogether. In 1980 the new official nomenclature of the American Psychiatric Association (DSM-III) designated chronic depressive states under the term Dysthymic Disorder and placed this category in the Affective Disorders section of that nosology. This served to emphasize the possible association between chronic depression and affective illness, and to stimulate research on the pharmacology of chronic depression. Several reports have now been published describing positive responses of patients with chronic “characterologic” depression or Dysthymic Disorder to treatment with thymoleptic medications (Akiskal et al., 1980; Paykel et al., 1982; Harrison et al., 1986; Vallejo et al., 1987; Kocsis et al., 1988a, b). These developments have influenced the thinking and the practice of clinical psychiatry. Clinicians are now much more likely to view chronic or “lifelong” depressions as a form of affective illness and to prescribe adequate trials of antidepressant medication for treatment of these conditions.