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Current Psychiatry Reports

, Volume 10, Issue 6, pp 458–464 | Cite as

Chronic depression: Update on classification and treatment

  • Dana C. Torpey
  • Daniel N. Klein
Article

Abstract

A significant proportion of patients with depressive disorders suffer from chronic conditions. The DSM-IV recognizes several forms of chronic depression. Chronic depressions differ from nonchronic major depressive disorder (MDD) on many clinical, psychosocial, and familial variables. However, less support exists for current distinctions between the various forms of chronic depression. Antidepressant medications and at least some forms of psychotherapy are efficacious in treating chronic depression, and the combination of pharmacotherapy and psychotherapy appears to be superior to either monotherapy alone. Still, chronic depression is often inadequately treated, and many patients fail to respond or continue to experience residual symptoms after treatment. An important direction for future research is to elucidate the multiple pathways to chronic depression and to tailor treatments to specific etiopathogenetic subgroups.

Keywords

Major Depressive Disorder Mood Disorder Nefazodone Amisulpride Attributional Style 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Arnow BA, Constantino MJ: Effectiveness of psychotherapy and combination treatment for chronic depression. J Clin Psychol 2003, 59:893–905.PubMedCrossRefGoogle Scholar
  2. 2.
    Klein DN: Dysthymia and chronic depression. In Psychopathology: History, Theory, and Diagnosis. Edited by Craighead WE, Miklowitz DJ, Craighead LW. Hoboken, NJ: John Wiley & Sons; 2008:329–365.Google Scholar
  3. 3.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4 (text revision). Washington, DC: American Psychiatric Association; 2000.Google Scholar
  4. 4.
    Keller MB, Klein DN, Hirschfeld RMA, et al.: Results of the DSM-IV Mood Disorders Field Trial. Am J Psychiatry 1995, 152:843–849.PubMedGoogle Scholar
  5. 5.
    Gilmer WS, Trivedi MH, Rush AJ, et al.: Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand 2005, 112:425–433.PubMedCrossRefGoogle Scholar
  6. 6.
    Keller MB, Shapiro RW: “Double depression”: superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry 1982, 139:438–442.PubMedGoogle Scholar
  7. 7.
    Klein DN, Shankman SA, Rose S: Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry 2006, 163:872–880.PubMedCrossRefGoogle Scholar
  8. 8.
    Judd LL, Paulus MJ, Schettler PJ: Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry 2000, 157:1501–1504.PubMedCrossRefGoogle Scholar
  9. 9.
    Mondimore FM, Zandi PP, MacKinnon DF, et al.: Familial aggregation of illness chronicity in recurrent, early-onset major depression pedigrees. Am J Psychiatry 2006, 163:1554–1560.PubMedCrossRefGoogle Scholar
  10. 10.
    Karlsson L, Pelkonen M, Heilä H, et al.: Differences in the clinical characteristics of adolescent depressive disorders. Depress Anxiety 2007, 24:421–432.PubMedCrossRefGoogle Scholar
  11. 11.
    Akiskal HS, Kilzieh N, Maser JD, et al.: The distinct temperament profiles of bipolar I, bipolar II, and unipolar patients. J Affect Disord 2006, 92:19–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Markianos M, Tripodianakis J, Sarantidis D, Hatzimanolis J: Plasma testosterone and dehydroepiandrosterone sulfate in male and female patients with dysthymic disorder. J Affect Disord 2007, 101:255–258.PubMedCrossRefGoogle Scholar
  13. 13.
    McCullough JP Jr, Klein DN, Borian FE, et al.: Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2. J Abnorm Psychol 2003, 112:614–622.PubMedCrossRefGoogle Scholar
  14. 14.
    Mondimore FM, Zandi PP, MacKinnon DF, et al.: A comparison of the familiality of chronic depression in recurrent early-onset depression pedigrees using different definitions of chronicity. J Affect Disord 2007, 100:171–177.PubMedCrossRefGoogle Scholar
  15. 15.
    Klein DN, Schatzberg AF, McCullough JP, et al.: Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response. J Affect Disord 1999, 55:149–157.PubMedCrossRefGoogle Scholar
  16. 16.
    Dougherty LR, Klein DN, Davila J: A growth curve analysis of the course of dysthymic disorder: the effects of chronic stress and moderation by adverse parent-child relationships and family history. J Consult Clin Psychol 2004, 72:1012–1021.PubMedCrossRefGoogle Scholar
  17. 17.
    Nemeroff CG, Heim CM, Thase ME, et al.: Differential responses to psychotherapy versus pharmacotherapy in the treatment for patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A 2003, 100:14293–14296.PubMedCrossRefGoogle Scholar
  18. 18.
    Klein DN, Shankman SA, Rose S: Dysthymic disorder and double depression: prediction of 10-year course trajectories and outcomes. J Psychiatr Res 2008, 42:408–415.PubMedCrossRefGoogle Scholar
  19. 19.
    de Lima MS, Hotoph M, Wessely S: The efficacy of drug treatments for dysthymia: a systematic review and metaanalysis. Psychol Med 1999, 29:1273–1289.PubMedCrossRefGoogle Scholar
  20. 20.
    Kocsis JH: Pharmacotherapy for chronic depression. J Clin Psychol 2003, 59:885–892.PubMedCrossRefGoogle Scholar
  21. 21.
    Gelenberg AJ, Trivedi MH, Rush AJ, et al.: Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression. Biol Psychiatry 2003, 54:806–817.PubMedCrossRefGoogle Scholar
  22. 22.
    Kocsis JH, Gelenberg AJ, Rothbaum B, et al.: Chronic forms of major depression are still undertreated in the 21st century: systematic assessment of 801 patients presenting for treatment. J Affect Disord 2008, 110:55–61.PubMedCrossRefGoogle Scholar
  23. 23.
    Keller MB, Harrison W, Fawcett JA, et al.: Treatment of chronic depression with sertraline or imipramine: preliminary blinded response rates and high rates of undertreatment in the community. Psychopharm Bull 1995, 35:205–212.Google Scholar
  24. 24.
    Schatzberg AF, Koran LM, Keller MB, et al.: Double-blind switch study of imipramine or sertraline treatment of antidepressant-resistant chronic depression. Arch Gen Psychiatry 2002, 59:233–239.PubMedCrossRefGoogle Scholar
  25. 25.
    Zanardi R, Smeraldi E: A double-blind, randomized, controlled clinical trial of acetyl-L-carnitine vs. amisulpride in the treatment of dysthymia. Eur Neuropsychopharmacol 2006, 16:281–287.PubMedCrossRefGoogle Scholar
  26. 26.
    Koran LM, Aboujaoude EN, Gamel NN: Duloxetine treatment of dysthymia and double depression: an open-label trial. J Clin Psychiatry 2007, 68:761–765.PubMedGoogle Scholar
  27. 27.
    McCullough JP: Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford; 2000.Google Scholar
  28. 28.
    Keller MB, McCullough JP, Klein DN, et al.: A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 2000, 342:1462–1470.PubMedCrossRefGoogle Scholar
  29. 29.
    Klein DN, Santiago NJ, Vivian D, et al.: Cognitive behavior analysis system of psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol 2004, 72:681–688.PubMedCrossRefGoogle Scholar
  30. 30.
    Klerman GL, Weissman MM, Rounsaville BJ, et al.: Interpersonal Psychotherapy of Depression. New York: Basic Books; 1984.Google Scholar
  31. 31.
    Markowitz JC: Interpersonal Psychotherapy for Dysthymic Disorder. Washington, DC: American Psychiatric Press; 1998.Google Scholar
  32. 32.
    Markowitz JC, Kocsis JH, Bleiberg KL, et al.: A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients. J Affect Disord 2005, 89:167–175.PubMedCrossRefGoogle Scholar
  33. 33.
    Markowitz JC, Kocsis JH, Christos P, et al.: Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence. J Nerv Ment Dis 2008, 196:468–474.PubMedCrossRefGoogle Scholar
  34. 34.
    den Boer PC, Wiersma D, Ten Vaarwerk I, et al.: Cognitive self-therapy for chronic depression and anxiety: a multicentre randomized controlled study. Psychol Med 2007, 37:329–339.CrossRefGoogle Scholar
  35. 35.
    de Maat SM, Dekker J, Schoevers RA, de Jonghe F: Relative efficacy of psychotherapy and combined therapy in the treatment of depression: a meta-analysis. Eur Psychiatry 2007, 22:1–8.PubMedGoogle Scholar
  36. 36.
    Schramm E, Schneider D, Zobel I, et al.: Efficacy of interpersonal psychotherapy plus pharmacotherapy in chronically depressed inpatients. J Affect Disord 2008, 109:65–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Arnow BA, Blasey C, Manber R, et al.: Dropouts versus completers among chronically depressed outpatients. J Affect Disord 2007, 97:197–202.PubMedCrossRefGoogle Scholar
  38. 38.
    Harvey AT, Silkey BS, Kornstein SG, Clary CM: Acute worsening of chronic depression during a double-blind, randomized clinical trial of antidepressant efficacy: differences by sex and menopausal status. J Clin Psychiatry 2007, 68:951–958.PubMedCrossRefGoogle Scholar
  39. 39.
    Kronmüller K-T, Victor D, Schenkenbach C, et al.: Knowledge about affective disorders and outcome of depression. J Affect Disord 2007, 104:155–160.PubMedCrossRefGoogle Scholar
  40. 40.
    Nolen-Hoeksema S: The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol 2000, 109:504–511.PubMedCrossRefGoogle Scholar
  41. 41.
    Kelly O, Matheson K, Ravindran A, et al.: Ruminative coping among patients with dysthymia before and after pharmacotherapy. Depress Anxiety 2007, 24:233–243.PubMedCrossRefGoogle Scholar
  42. 42.
    Blalock JA, Fouladi RT, Cinciripini PM, et al.: Cognitive and behavioral mediators of combined pharmacotherapy and psychotherapy of chronic depression. Cognit Ther Res 2008, 32:197–211.CrossRefGoogle Scholar
  43. 43.
    Watkins E, Scott J, Wingrove J, et al.: Rumination-focused cognitive behaviour therapy for residual depression: a case series. Behav Res Ther 2007, 45:2144–2154.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of PsychologyStony Brook UniversityStony BrookUSA

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