Chronic depressions: Part 1. Clinical and familial characteristics in 137 probands

Abstract

Factors associated with chronicity in 137 probands with 2 or more years of low-grade intermittent depression were evaluated in a naturalistic setting. Four groups were tentatively identified and chronicity related to: (1) early onset (<25 years) intermittent sub-syndromal or dysthymic depressions with positive family history for both unipolar and bipolar illness; (2) a spectrum of ‘unstable’ characterologic disorders with history for childhood object loss; (3) pre-existing non-affective psychiatric or incapacitating medical disorders, especially in combination; (4) incomplete remission from late-onset primary unipolar episode(s) with strong familial background for affective illness, multiple object losses, alcohol and sedative hypnotic dependence, superimposed incapacitating medical disorders, use of depressant antihypertensive agents, disabled spouses, and ‘marital deadlock’. Beneficial effects of thymoleptic drugs and practical psychotherapy occured in 45% of the total sample and were largely limited to groups 1 and 4. These findings argue against a common clinical stereotype that equates all chronic depressions with character disorder.