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Chronic Depression

Published online by Cambridge University Press:  02 January 2018

Jan Scott
Jan Scott*
Affiliation:
University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
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Abstract

Defining chronic depression as persistent symptoms for 2 or more years, a prevalence of chronic depression of 12–15% is found in the literature. A four-part classification of chronic depression is proposed: Chronic Primary Major Depression; Chronic Secondary Major Depression; Characterological or Chronic Minor Depression (Dysthymic Disorder); and ‘Double Depression’. The literature indicates several factors predicting chronicity in primary major depression: more at risk are female patients, particularly those with premorbid neurotic personality traits, individuals with unipolar disorders, and those with higher familial loading for such disorders. Other factors are the adequacy and appropriateness of the treatment given, and the length of illness episode prior to treatment being received. Larger studies with well-matched controls are needed.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 153 , Issue 3 , September 1988 , pp. 287 - 297
Copyright
Copyright © Royal College of Psychiatrists, 1988 

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References

Akiskal, H. S. (1982) Factors associated with incomplete recovery in primary depressive illness. Journal of Clinical Psychiatry, 43, 266–271.Google Scholar
Akiskal, H. S. (1983) Dysthymic disorder: psychopathology of proposed chronic depressive subtypes. American Journal of Psychiatry, 140, 11–20.Google ScholarPubMed
Akiskal, H. S. (1985) A proposed clinical approach to chronic and ‘resistant’ depressions: evaluation and treatment. Journal of Clinical Psychiatry, 46, 32–36.Google Scholar
Akiskal, H. S. (1986) The challenge of chronic depressions: diagnostic, etiologic, and therapeutic aspects. In Depression in Multi-disciplinary Perspective (ed. Dean, A.). New York: Brunner/Mazel.Google Scholar
Akiskal, H. S., Bitar, A. H., Puzantian, V. R., Rosenthal, T. L. & Parks, W. W. (1978) The nosological status of neurotic depression: a prospective three-to-four year follow-up examination in light of the primary–secondary and unipolar–bipolar dichotomies. Archives of General Psychiatry, 35, 756–766.Google Scholar
Akiskal, H. S., King, D., Rosenthal, T., Robinson, D. & Scott-Strauss, A. (1981) Chronic depressions – Part I. Clinical and familial characteristics in 137 probands. Journal of Affective Disorders, 3, 297–315.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington DC: APA.Google Scholar
Ananth, J. & Ruskin, R. (1974) Treatment of intractable depression. International Pharmacopsychiatrica, 9, 218–229.Google Scholar
Andreasen, N. C., Endicott, J., Spitzer, R. L. & Winokur, G. (1977) The family history method using diagnostic criteria: reliability and validity. Archives of General Psychiatry, 34, 1229–1235.CrossRefGoogle ScholarPubMed
Astrup, C., Fossum, A. & Holmboe, R. (1959) A follow-up study of 270 patients with acute affective psychosis. Acta Psychiatrica et Neurologica Scandinavica, Suppl. 135, 1–65.Google Scholar
Bebbington, P. E. (1982) The course and prognosis of affective disorders. In Handbook of Psychiatry 3: Psychoses of Uncertain Aetiology (eds Wing, J. K. & Wing, L.). Cambridge: Cambridge University Press.Google Scholar
Bebbington, P. E., Hurry, J. & Tennant, C. (1981) Epidemiology of mental disorders in Camberwell. Psychological Medicine, 11, 561–579.CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.Google Scholar
Berti Ceroni, G. B. & Pezzoli, A. (1984) La croniccizzazione della depressione nelle casalinghe di mezza eta: un rischio psichiatrico maggiore sottovalutato. Revisita Sperimentale di Freniatrica e Medicina Legale delle Alienazioni Mentali, 108, 294–331.Google Scholar
Berti Ceroni, G. B., Neri, C. & Pezzoli, A. (1984) Chronicity in major depression: a naturalistic prospective study. Journal of Affective Disorders, 7, 123–132.CrossRefGoogle ScholarPubMed
Bothwell, S. & Weissman, M. M. (1977) Social impairments four years after an acute depressive episode. American Journal of Orthopsychiatry, 47, 231–237.CrossRefGoogle ScholarPubMed
Boyd, H. I. & Weissman, M. M. (1981) Epidemiology of affective disorders. Archives of General Psychiatry, 38, 1039–1046.Google Scholar
Bratfos, O. & Haig, J. O. (1968) The course of manic–depressive psychosis: a follow-up investigation of 215 patients. Acta Scandinavica Psychiatrica, 44, 89–112.Google Scholar
Bridges, P. K. (1983) Point of view. British Journal of Psychiatry, 142, 676–687.Google Scholar
Brown, G. W. & Harris, T. (1978) Social Origins of Depression: A study of Psychiatric Disorders in Women. London: Tavistock Publications.Google Scholar
Carlson, G. A., Davenport, Y. B. & Jamison, K. (1977) A comparison of outcome in adolescent and late-onset bipolar manic depressive illness. American Journal of Psychiatry, 124, 134–139.CrossRefGoogle Scholar
Carranzo-Acevedo, J. (1974) Virus induced resistant depressions. Pharmacopsychiatrica, 7, 164–168.CrossRefGoogle Scholar
Cassano, G. B., Maggini, C. & Akiskal, H. (1983) Short-term, subchronic and chronic sequelae of affective disorders. The Psychiatric Clinics of North America, 6, 55–68.CrossRefGoogle ScholarPubMed
Cassano, G. B. & Akiskal, H. (1985) The long-term effects of depression. In The Affective Disorders (eds Davies, J. M. & Maas, J. W.). Washington DC: American Psychiatric Press.Google Scholar
Chodoff, P. (1972) The depressive personality: a critical review. Archives of General Psychiatry, 27, 666–673.Google Scholar
Coppen, A. (1974) The biochemistry of therapy-resistant depression. Pharmacopsychiatrica, 7, 85–87.Google Scholar
Deykin, E. Y. & Dimascio, A. (1972) Relationship of patient background characteristics to efficacy of pharmacotherapy in depression. Journal of Nervous and Mental Diseases, 155, 209–215.CrossRefGoogle ScholarPubMed
Digo, R. (1955) Melancholie: étude clinique. Encyclopedie Medico-Chirurgicale. Paris, 2, 37210 A10.Google Scholar
Downing, R. W. & Rickels, K. (1973) Predictors of response to amitryptiline and placebo in three outpatient treatment settings. Journal of Nervous and Mental Diseases, 156, 109–129.CrossRefGoogle Scholar
Eysenck, H. J. & Eysenck, S. B. G. (1974) Manual of the Eysenck Personality Inventory, 4th edn. London: University.Google Scholar
Fennell, M. T. V. & Teasdale, J. D. (1983) Cognitive therapy with chronic drug-refractory outpatients: a note of caution. Cognitive Therapy and Research, 6, 455–460.Google Scholar
Fras, I., Littin, E. M. & Pearson, J. S. (1967) Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. American Journal of Psychiatry, 123, 1553–1562.CrossRefGoogle ScholarPubMed
Freyhan, F. A. (1978) Treatment resistant or untreatable? Comprehensive Psychiatry, 19, 97–101.CrossRefGoogle ScholarPubMed
Garvey, M. J., Tollefson, G. D. & Tuason, V. S. (1986) Is chronic primary major depression a distinct subtype? Comprehensive Psychiatry, 27, 446–448.CrossRefGoogle Scholar
Guensberger, E. & Fleischer, J. (1972) Psychopathology of chronic depression and its classificational position. Schwiezer Archiv fur Neurologie Neurochirurgie und Psychiatrie, 110, 109–119.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hansen, C. R., Malecha, M., MacKenzie, T. B. & Kroll, J. (1983) Copper and zinc deficiencies in association with depression and neurological findings. Biological Psychiatry, 18, 395–400.Google Scholar
Hauri, P., Chernik, D., Hawkins, D. & Mendels, J. (1974) Sleep of depressed patients in remission. Archives of General Psychiatry, 31, 386–391.Google Scholar
Helmchen, H. (1974) Symptomatology of therapy-resistant depression. Pharmacopsychiatrica, 7, 145–155.Google Scholar
Hirschfeld, R. M. A., Klerman, G. L., Andreasen, N. C., Clayton, P. J. & Keller, M. B. (1986) Psycho-social predictors of chronicity in depressed patients. British Journal of Psychiatry, 148, 648–654.CrossRefGoogle ScholarPubMed
Hornstra, R. J. & Klassen, D. (1977) The course of depression. Comprehensive Psychiatry, 18, 119–125.Google Scholar
Houillon, P. & Dumont-Girard, P. (1985) Depressions resistantes en phase de chronicite: aspects cliniques et pharmacologiques: a propos de vingt-cinq observations. Annales Medico Psychologiques, 7, 628–633.Google Scholar
Huston, P. E. & Locher, L. M. (1948) Involutional psychosis: course when untreated and when treated with electric shock. Archives of Neurology and Psychiatry, 59, 385–394.CrossRefGoogle ScholarPubMed
Johnston, D. A. W. (1974) A study of the use of antidepressant medication in general practice. British Journal of Psychiatry, 125, 186–192.CrossRefGoogle Scholar
Johnstone, E. C., Owens, D. G. C., Crow, T. J., Colter, N., Lawton, R. J. & Kreel, L. (1986) Hypothyroidism as a correlate of lateral ventricular enlargement in manic–depressive and neurotic illness. British Journal of Psychiatry, 148, 317–321.CrossRefGoogle ScholarPubMed
Kay, D. W. K., Garside, R. F., Roy, J. R. & Beamish, P. (1969) ‘Endogenous’ and ‘neurotic’ syndromes of depression: a 5- to 7-year follow-up of 104 cases. British Journal of Psychiatry, 115, 389–399.CrossRefGoogle ScholarPubMed
Keller, M. B. (1985) Chronic and recurrent affective disorders: incidence, course and influencing factors. In Chronic Treatments in Neuropsychiatry (eds Kemali, D. & Racagni, G.). New York: Raven Press.Google Scholar
Keller, M. B. & Shapiro, R. W. (1982) ‘Double depression’: super-imposition of acute depressive episodes on chronic depressive disorders. American Journal of Psychiatry, 139, 438–442.Google Scholar
Keller, M. B., Klerman, G. L., Lavori, P. W., Fawcett, J. A., Coryell, W. & Endicott, J. (1982) Treatment received by depressed patients. Journal of the American Medical Association, 248, 1848–1855.CrossRefGoogle ScholarPubMed
Keller, M. B., Klerman, G. L., Lavori, P. W., Coryell, W., Endicott, J. & Taylor, J. (1984) Long-term outcome of episodes of major depression: clinical and public health significance. Journal of the American Medical Association, 252, 788–792.Google Scholar
Keller, M. B., Lavori, P. W., Klerman, G. L., Andreasen, N. C., Endicott, J., Coryell, W., Fawcett, J., Rice, J. P. & Hirschfeld, R. M. A. (1986a) Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Archives of General Psychiatry, 43, 458–466.Google Scholar
Keller, M. B., Lavori, P. W., Klerman, G. L., Rice, J. P., Coryell, W. & Hirschfeld, R. M. A. (1986b) The persistent risk of chronicity in recurrent episodes of non-bipolar major depressive disorder: a prospective follow-up. American Journal of Psychiatry, 143, 24–28.Google Scholar
Kendall, R. E. & DiScipio, W. J. (1968) Eysenck Personality Inventory scores for patients with depressive illnesses. British Journal of Psychiatry, 114, 767–770.Google Scholar
Kerr, T. A., Schapira, K., Roth, M. & Garside, R. (1970) The relationship between the Maudsley Personality Inventory and the course of affective disorders. British Journal of Psychiatry, 116, 11–19.CrossRefGoogle ScholarPubMed
Kerr, T. A., Roth, M., Schapira, K. & Gurney, C. (1972) The assessment and prediction of outcome in affective disorders. British Journal of Psychiatry, 121, 167–174.CrossRefGoogle ScholarPubMed
Kiloh, L. G., Ball, J. R. B. & Garside, R. F. (1962) Prognostic factors in treatment of depressive states with imipramine. British Medical Journal, i, 1225–1227.CrossRefGoogle Scholar
Kinkelin, M. (1953) Verlauf und prognose des manisch–depressiven Irreseins. Schweizer Archiv fur Neurologie und Psychiatrie, 73, 100–146.Google Scholar
Klein, D. F. (1974) Endogenomorphic depression: a conceptual and terminological revision. Archives of General Psychiatry, 31, 447–454.CrossRefGoogle ScholarPubMed
Kotin, J., Post, R. M. & Goodwin, F. K. (1973) Drug treatment of depressed patients referred for hospialisation. American Journal of Psychiatry, 130, 1139–1141.Google Scholar
Kraepelin, E. (1913) Translated as Lectures on Clinical Psychiatry by Johnstone, T. London: Bailliere Tindall & Cox.Google Scholar
Kraepelin, E. (1921) Manic–Depressive Insanity and Paranoia. Edinburgh: E. & S. Livingstone.CrossRefGoogle Scholar
Kraines, S. H. (1957) Therapy of the chronic depressions. Diseases of the Nervous System, 28, 577–584.Google Scholar
Kupfer, D. J. (1976) REM latency: a psychobiological marker for primary depressive disease. Biological Psychiatry, 11, 159–174.Google ScholarPubMed
Kupfer, D. J. & Spiker, D. G. (1981) Refractory depression: prediction of non-response by clinical indicators. Journal of Clinical Psychiatry, 42, 307–312.Google Scholar
Lancet (1986) Predicting chronicity in depression. The Lancet, ii, 897–898.Google Scholar
Lee, A. & Murray, R. (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry (in press).Google Scholar
Lehmann, H. E. (1974) Therapy-resistant depression: a clinical classification. Pharmacopsychiatrica, 7, 156–163.Google Scholar
Le-Quan Bui, K. H., Plaisant, O., Leboyer, M., Gay, C., Kamal, L., Devynck, M. & Meyer, P. (1984) Reduced platelet serotonin in depression. Psychiatry Research, 13, 129–139.Google Scholar
Lewis, A. J. (1936) Melancholia: prognostic study and case material. Journal of Mental Science, 82, 488–558.CrossRefGoogle Scholar
Lundquist, G. (1945) Prognosis and course of manic–depressive psychoses: a follow-up study of 319 first admissions. Acta Scandinavica Psychiatrica et Neurologica, Suppl. 35, 1–96.Google Scholar
Mann, S. & Cree, W. (1976) ‘New’ long-stay psychiatric patients: a national survey of fifteen mental hospitals in England and Wales, 1972/3. Psychological Medicine, 6, 603–616.Google Scholar
Marshall, E. F., Kennedy, W. N. & Eccleston, D. (1985) Whole blood serotonin and plasma tryptophan using high pressure liquid chromatography with electrochemical detection. Biochemical Medicine and Metabolic Biology, 37, 81–86.CrossRefGoogle Scholar
Matarazzo, E. B. (1976) Persistent depression and temporal lobe dysrhythmia. Arquivos de Neuro-Psiquiatrica, 34, 173–187.Google Scholar
McCreadie, R. G., Wilson, A. O. A. & Burton, L. L. (1983) The Scottish survey of ‘new chronic’ inpatients. British Journal of Psychiatry, 143, 564–571.CrossRefGoogle ScholarPubMed
Morrison, J., Winokur, G., Crowe, R. & Clancy, J. (1973) The Iowa 500: the first follow-up. Archives of General Psychiatry, 29, 678–682.CrossRefGoogle ScholarPubMed
Murphy, E. (1983) The prognosis of depression in old age. British Journal of Psychiatry, 142, 111–119.CrossRefGoogle ScholarPubMed
Murphy, G. E., Woodruff, R. A., Herjanic, M. & Super, G. (1974) Variability of the clinical course of primary affective disorders. Archives of General Psychiatry, 30, 757–761.Google Scholar
Niederlander, W. G. (1968) Clinical observations on the ‘survivors syndrome’. International Journal of Psychoanalysis, 49, 313–315.Google Scholar
Nuller, Y. L., Kalinin, O. M. & Rubtsova, S. (1972) Factor analysis of the course of manic–depressive psychosis. Zhurnal Nevropatologii i Psikhiatrii, 72, 548–554.Google ScholarPubMed
Nystrom, S. (1979) Depression: factors related to 10 year prognosis. Acta Psychiatrica Scandinavica, 60, 225–238.Google Scholar
Oules, J. (1974) Les états dépressifs chimiorésistants. Annales Medico Psychologiques, 4, 57–64.Google Scholar
Paykel, E. S. & Weissman, M. M. (1973) Social adjustment and depression: a controlled study: a longitudinal study. Archives of General Psychiatry, 28, 659–663.Google Scholar
Paykel, E. S., Klerman, G. L. & Prusoff, B. A. (1974) Prognosis of depression and the endogenous–neurotic distinction. Psychological Medicine, 4, 57–64.Google Scholar
Paykel, E. S., & Hale, A. S. (1985) Recent advances in the treatment of depression. In The Biology of Depression (ed. Deakin, J. F. W.). London: Gaskell Publications.Google Scholar
Perez de Francisco, C. (1979) Therapy resistant depressions. International Pharmacopsychiatrica, 14, 71–78.CrossRefGoogle ScholarPubMed
Pomara, N. & Gershon, S. (1984) Treatment-resistant depression in an elderly patient with pancreatic carcinoma: case report. Journal of Clinical Psychiatry, 45, 439–440.Google Scholar
Post, F. (1972) The management and nature of depressive illnesses in late life: a follow-through study. British Journal of Psychiatry, 121, 393–404.Google Scholar
Quitkin, F. M. (1985) The importance of dosage in prescribing antidepressants. British Journal of Psychiatry, 147, 593–597.Google Scholar
Regis, E. (1923) Precis de Psychiatrie, 6th edn. Paris: G. Doin.Google Scholar
Robins, E. & Guze, S. (1972) Classification of affective disorders: the primary–secondary, the endogenous–reactive and the neurotic–psychotic dichotomies. In Recent Advances in Psychobiology of the Depressive Illnesses (eds Williams, T. A., Katz, M. M. & Shield, J. A.). Washington DC: US Printing Office.Google Scholar
Rounsaville, B. J., Sholomaskas, D. & Prusoff, B. A. (1980) Chronic mood disorders in depressed outpatients: diagnosis and response to pharmacotherapy. Journal of Affective Disorders, 2, 73–88.Google Scholar
Rowe, D. (1971) Poor prognosis in a case of depression as predicted by the repertory grid. British Journal of Psychiatry, 118, 297–300.Google Scholar
Scott, J., Barker, W. A. & Eccleston, D. (1988) The Newcastle chronic depression study: patient characteristics and factors associated with chronicity. British Journal of Psychiatry, 152, 28–33.Google Scholar
Schatzberg, A. F., Cole, J. O., Cohen, B. M., Altesman, R. I. & Sniffen, C. M. (1983) Survey of depressed patients who have failed to respond to treatment. In The Affective Disorders (eds Davis, J. M. & Maas, J. W.). Washington DC: American Psychiatric Press.Google Scholar
Schneider, K. (1958) Translated as Psychopathic Personalities by Hamilton, M. London: Cassell.Google Scholar
Shaminina, V. M., Romel, T. E., Kontsevoy, V. A. & Akopova, I. L. (1973) Chronic depressions in endogenous psychoses: some data on their typology and the conditions of their treatment. Foreign Psychiatry, 2, 38–61.Google Scholar
Shobe, F. O. & Brion, P. (1971) Long-term prognosis in manic–depressive illness. Archives of General Psychiatry, 24, 334–337.Google Scholar
Sjobring, H. (1973) Personality structure and development: a model and its application. Acta Psychiatrica Scandinavica, Suppl. 244.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Stendstedt, A. (1952) A study in manic–depressive psychosis: clinical, social and genetic investigations. Acta Psychiatrica et Neurologica Scandinavica, Suppl. 79, 1–111.Google Scholar
Taschev, T. (1974) The course and prognosis of depression on the basis of 652 patients deceased. In Classification and Prediction of Outcome of Depression (ed. Angst, J.). Stuttgart: Schattauer.Google Scholar
Toone, B. K. & Ron, M. (1977) A study of predictive factors in depressive disorders of poor outcome. British Journal of Psychiatry, 131, 587–591.CrossRefGoogle ScholarPubMed
Weiser, St. (1969) Uber den defekt bei phasischen Psychosen. In Das depressive Syndrom (eds Hippius, H. & Seibach, H.). Munich: Urban & Schwarzenberg.Google Scholar
Weissman, M. M. & Paykel, E. (1974) The depressed woman: a study of social relationships. Chicago: University of Chicago.Google Scholar
Weissman, M. M., Kasl, S. V. & Klerman, G. L. (1976) Follow-up of depressed women after maintenance treatment. American Journal of Psychiatry, 133, 757–760.Google Scholar
Weissman, M. M., & Klerman, G. L. (1977) The chronic depressive in the community: unrecognised and poorly treated. Comprehensive Psychiatry, 18, 523–532.Google Scholar
Weissman, M. M., & Myers, J. K. (1978) Affective disorders in a U.S. urban community. Archives of General Psychiatry, 35, 1304–1311.Google Scholar
Weissman, M. M., & Akiskal, H. S. (1984) The role of psychotherapy in chronic depression: a proposal. Comprehensive Psychiatry, 25, 23–31.Google Scholar
Weitbrecht, H. J. (1969) Psicosi endogene depressive e maniacali. In Psichiatria del Presente (eds Gruk, H. W., June, R., Mayer-Gross, W. & Muller, M.). Vaduz-Leichtenstein: Luxusansgoben Rerkord.Google Scholar
Wertham, F. I. (1929) A group of benign chronic psychoses: prolonged manic excitements. American Journal of Psychiatry, 86, 17–78.Google Scholar
Weygandt, G. (1908) Atlante e Manuale di Psychiatria. Milan: Societa Editrice Libraria.Google Scholar
Winokur, G. & Morrison, J. (1973) The Iowa 500: follow-up of 225 depressives. British Journal of Psychiatry, 123, 543–548.CrossRefGoogle ScholarPubMed
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: World Health Organization.Google Scholar
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