Non-chronic Depression Research Articles

Chronic vs non-chronic depression in psychiatric inpatient care - Data from a large naturalistic multicenter trial

BackgroundAround 20% - 30% of depressed individuals experience a chronic form of depression lasting two or more years. This naturalistic study investigates the characteristics and the course of chronic depressed patients (CD) during standard antidepressant treatment in comparison to not chronically depressed (NCD) patients. MethodsData of 954 patients were drawn from the prospective naturalistic, multicenter study of the German research network on depression, CD was met as classifier by 113 patients (11.8%), whereas 841 patients (88.2%) had non-chronic courses (NCD). ResultsCD was significantly associated with a low age at onset, use of benzodiazepines, psychotherapy at baseline, substance abuse, a depressive personality disorder and a low degree of extraversion. CD patients showed a longer hospital stay, lower remission rates, increased rates of suicidal ideation as well as higher depression scores at discharge. In addition, individuals with chronic depression continued to obtain higher neuroticism scores and lower extraversion scores at discharge. LimitationResults were assessed by a post-hoc analysis, based on prospectively collected data. ConclusionCD patients have an inferior outcome in clinical measures as well as personality dimensions (i.e. low extraversion) compared to non-CD patients. These findings support the notion that CD patients entering a setting of standard psychiatric inpatient care will show less benefit compared to non-CD patients, and that this difference as such may be used as a stratifying marker for providing specialized psychiatric treatment with optimized pharmacological and psychotherapeutic protocols.

Offspring of Mothers With Histories of Chronic and Non-chronic Depression: Symptom Trajectories From Ages 6 to 15.

Several studies have reported that individuals with chronic depression have higher rates of depressive disorders, and particularly chronic depression, in their first-degree relatives, compared to those with non-chronic (episodic) major depression. In addition, a few studies have suggested that offspring of parents with chronic depression have elevated rates of depression and other psychopathology. Most of this work uses the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines chronicity as persistence for at least 2 years. An alternative is a life-course, approach, which evaluates overall course since first onset. We examined the trajectories of depressive, anxiety, and externalizing symptoms in a community sample of 577 offspring of mothers with histories of chronic depression, non-chronic (or episodic) major depression, and no depression using prospective, multi-informant assessments from age 6 to age 15. Offspring of mothers with a history of depression exhibited higher levels of depression, anxiety, and externalizing symptoms than offspring of mothers who were never depressed. Moreover, the effects of maternal depression on offspring depression, anxiety, and externalizing symptoms were more pronounced for mothers with histories of chronic than non-chronic depression, particularly when the life-course approach to classifying chronicity was used. These data suggest that research that combines chronic and non-chronic depressions includes significant heterogeneity that may hinder understanding of etiology and reduce the likelihood of developing a cumulative and replicable literature. In addition, these findings have significant implications for prevention and treatment.

Double trouble: Do symptom severity and duration interact to predicting treatment outcomes in adolescent depression?

Studies suggest that depression severity and duration interact to predict outcomes in depression treatment. To our knowledge, no study has explored this question in a sample with a placebo control, two therapies, and their combination nor with adolescents. We used data from the Treatment of Adolescent Depression Study (N = 439), in which adolescent were randomized to placebo (PBO), cognitive-behavioral therapy (CBT), antidepressants medications (MEDs), or their combination (COMB). We explore the interaction between depression severity, chronicity, and treatments (vs. placebo) in predicting outcomes. There was interaction between severity and chronicity when comparing COMB and CBT with PBO, but not MEDs. In non-chronic depression, the effects of CBT were inversely related to severity to the point that CBT appeared iatrogenic with more severe depression. In chronic depression, the effects of CBT did not vary by severity, but the relative effects of COMB grew, being smallest in milder, more dysthymic-like depression, and largest in chronic-severe depression. These findings support calls to classify depression by severity and chronicity as well efforts to risk stratify patients to different intensity of care according to these variables.

Predictors of response and remission in a naturalistic inpatient sample undergoing multimodal treatment for depression

BackgroundMany depressed patients do not achieve response or remission despite adequate treatment. Identifying predictors of outcome can contribute to developing therapeutic algorithms for difficult-to-treat depression. Therefore, we examined clinical predictors of response and remission in a naturalistic inpatient sample undergoing multimodal treatment for depression. MethodsThree hundred and fifty-one consecutive inpatients admitted to a tertiary care university hospital (specialized psychiatry unit for treatment of unipolar and bipolar depression) between January 2014 and December 2016 were characterized by a set of sociodemographic and clinical variables. The predictive value of these variables for response (≥ 50% decrease from baseline Montgomery–Åsberg Depression Rating Scale (MADRS) score) and remission (MADRS score at discharge < 10) were explored using bivariate analysis and logistic regression. ResultsGreater symptom severity and fewer psychotropic medications at the time of admission predicted response. Remission rates were higher for patients with non-chronic depression, higher number of previous depressive episodes, fewer psychotropic medications and less severe depression at admission. LimitationsThis was a retrospective study without a control group. The sample was drawn from a single inpatient ward specialized for difficult-to-treat depression. ConclusionsGreater baseline depression severity might be a proxy for a less chronic course of depression thereby explaining its association with greater response rates. Fewer episodes in the past and polypharmacy could indicate treatment-resistance and chronicity, contributing to lower remission rates. Therefore, preventing chronicity should be a central aim of depression treatment.

Peripheral Immune Alterations in Major Depression: The Role of Subtypes and Pathogenetic Characteristics.

Depression has been associated with peripheral inflammatory processes and alterations in cellular immunity. Growing evidence suggests that immunological alterations may neither be necessary nor sufficient to induce depression in general, but seem to be associated with specific features. Using baseline data from the Outcome of Psychological Interventions in Depression trial, this exploratory study examines associations between depression subtypes and pathogenetic characteristics (i.e., melancholic vs non-melancholic depression, chronic vs non-chronic depression, age of onset, cognitive-affective and somatic symptom dimensions) with plasma levels of C-reactive protein (CRP), interleukin (IL)-6, IL-10, and numbers of leukocyte subpopulations in 98 patients with major depression (MD) and 30 age and sex-matched controls. Patients with MD exhibited higher CRP levels, higher neutrophil and monocyte counts, lower IL-10 levels, and an increased neutrophil to lymphocyte ratio (NLR) than controls. Patient with later age of onset had higher levels of two inflammatory markers (CRP, NLR) and lower cytotoxic T cell counts after adjusting for sociodemographics, lifestyle factors, and antidepressants. Furthermore, lower anti-inflammatory IL-10 levels were related to more severe somatic depressive symptoms. These results confirm and extend previous findings suggesting that increased levels of CRP are associated with a later onset of depression and demonstrate that also NLR as a subclinical inflammatory marker is related to a later onset of depression.

From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the "emperor's new treatments" for mental illnesses?

“The drugs don't work” was one of the hit singles from The Verve's album Urban Hymns , released in 1997. The song was written by lead singer Richard Ashcroft relating to his drug abuse, but it might well relate to the modern treatments for mental illnesses. More than half a century after neuroleptics, antidepressants, benzodiazepines, antipsychotics, behavior therapy, and cognitive treatment were introduced, it is prudent to ask whether “the drugs don't work”. During the past 50 years, the industrialized world has seen a dichotomy between loudly proclaimed therapeutic breakthroughs and rapidly rising numbers of people on disability payments because of mental illness. We hear that antipsychotic, antidepressant, and anti‐anxiety drugs as well as behavior therapy and newer treatments have radically improved what was described as a dismal fate of people suffering from mental disorders. Simultaneously, the percentage of disabled mentally ill patients in the USA has risen by more than 600% since the 1950s (Whitaker, 2010) and similar rates are seen in European countries. Most epidemiologists agree that this “epidemic” is not caused by increased incidence. Moreover, the once rapid succession of new therapeutic developments seems to have halted, at least in pharmacology, as big companies are withdrawing from research on mental disorders. How can this apparent contradiction be explained? Could it be that therapeutic progress is much less than we think or are being told? Could it be that the course of depression, anxiety, schizophrenia, or ADHD has been altered for the worse? Could it be that we cannot make therapeutic progress because the concept of mental illness and its treatment is deeply flawed? There are strong reasons to assume that all three suspicions are in fact true. So, what do we know about the efficiency of pharmacological and psychological treatments? In regard to short‐term outcomes, pharmacotherapy is clearly …

Depression study with flexible design shows benefit of combination therapy

The Brown University Psychopharmacology UpdateVolume 25, Issue 12 p. 1-6 Depression Treatment Depression study with flexible design shows benefit of combination therapy First published: 25 November 2014 https://doi.org/10.1002/pu.30001Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract A study that the author of an accompanying journal editorial calls “one of the most important studies ever undertaken” to evaluate combined pharmacotherapy and psychotherapy for major depression has found an enhanced rate of recovery with combination treatment for persons with severe nonchronic depression. The study design was noteworthy in that clinicians had the ability to use aggressive dosing of antidepressants and to switch medications if patients were not achieving results. Volume25, Issue12December 2014Pages 1-6 RelatedInformation

Combination Therapy Better for Severe Depression

Compared with medication alone, the combination of optimized medical treatment and cognitive therapy affected a high rate of recovery for patients with severe, nonchronic major depressive disorder. Although the combination didn't significantly benefit patients with less severe or chronic depression, it doubled recovery rates among those with the most severe symptoms. The number needed to treat to achieve one recovery in this group was just three, Steven D. Hollon, PhD, and his colleagues reported (JAMA Psychiatry 2014;71:1157-64). The failure to observe a significant benefit among those less severely and chronically depressed patients was a disappointment, wrote Dr. Hollon, who is the Gertrude Conaway Professor of Psychology at Vanderbilt University, Nashville, TN. But this dichotomy could be employed as a way to pinpoint those most likely to respond to the combination. “[These moderators] could be used prescriptively to guide a more efficient allocation of treatment resources. Given the higher cost of combined treatment, it might be reserved for patients with nonchronic, more severe depression.” The 42-month trial randomized 452 patients with chronic or recurrent major depressive disorder to optimized antidepressant treatment or antidepressants plus cognitive therapy. They were a mean of 43 years old with a mean score of 22 on the Hamilton Rating Scale for Depression. Recurrent depression was present in 83%; chronic, in 35%. The overall dropout rate was 23%, but attrition was significantly lower in the combination group (19% vs. 27%). Overall, the rates of remission did not significantly differ between the groups. However, recovery was significantly more common among those who had the combination therapy (73% vs. 63%; HR, 1.33). An exploratory analysis determined that the timing of depression and its severity significantly influenced outcomes. Among those with either less severe depression or high-severity chronic depression, the treatment effect was small. But among those with severe, nonchronic depression, a significant benefit was found. The recovery rate for these patients was significantly higher with combination therapy.

Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.

Antidepressant medication (ADM) is efficacious in the treatment of depression, but not all patients achieve remission and fewer still achieve recovery with ADM alone. To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in major depressive disorder (MDD). A total of 452 adult outpatients with chronic or recurrent MDD participated in a trial conducted in research clinics at 3 university medical centers in the United States. The patients were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Treatment was continued for up to 42 months until recovery was achieved. Antidepressant medication with or without CT. Blind evaluations of recovery with a modified version of the 17-item Hamilton Rating Scale for Depression and the Longitudinal Interval Follow-up Evaluation. Combined treatment enhanced the rate of recovery vs treatment with ADM alone (72.6% vs 62.5%; t451 = 2.45; P = .01; hazard ratio [HR], 1.33; 95% CI, 1.06-1.68; number needed to treat [NNT], 10; 95% CI, 5-72). This effect was conditioned on interactions with severity (t451 = 1.97; P = .05; NNT, 5) and chronicity (χ2 = 7.46; P = .02; NNT, 6) such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs 51.7%; n = 146; t145 = 3.96; P = .001; HR, 2.34; 95% CI, 1.54-3.57; NNT, 3; 95% CI, 2-5). Fewer patients dropped out of combined treatment vs ADM treatment alone (18.9% vs 26.8%; t451 = -2.04; P = .04; HR, 0.66; 95% CI, 0.45-0.98). Remission rates did not differ significantly either as a main effect of treatment or as an interaction with severity or chronicity. Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P = .01). Patients who received combined treatment reported fewer serious adverse events than did patients who received ADMs alone (49 vs 71; P = .02), largely because they experienced less time in an MDD episode. Cognitive therapy combined with ADM treatment enhances the rates of recovery from MDD relative to ADMs alone, with the effect limited to patients with severe, nonchronic depression. clinicaltrials.gov Identifier: NCT00057577.

Toward a Cognitive Conceptualization of Dysthymia: Cognitive Behavioral Identification and Treatment of Patients with Dysthymia.

Archival records of three groups of outpatients, seen in a U.S. behavioral health clinic during 2009 and 2010, were examined. All had taken a battery of tests and measures at admission, including both the Millon Clinical Multiaxial Inventory-III (MCMI-III) and a questionnaire representing beliefs, attitudes, and behaviors, believed to be prototypical of dysthymia. The groups, identified on the basis of their MCMI-III profiles, were Dysthymia (n = 84), nonchronic Depression (n = 58), and Control (n = 120). Significant differences were found among the groups, in that the Dysthymia group had the highest level of agreement on 25 items of the questionnaire; the nonchronic Depression group had the second highest; and the Control group had the lowest level of agreement. Conceptual and therapeutic implications are discussed, as are various modalities considered to be effective in the treatment of patients with dysthymia.

Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder

The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis. The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing. Secondary analysis of a nationally representative household survey. Urban and rural census tracts. One individual between the ages of 16 and 85 years from 8841 households was interviewed for the survey. Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0). Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79). Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.

Prevalence and Correlates of Chronic Depression in the Canadian Community Health Survey: Mental Health and Well-Being

To determine the prevalence and correlates of chronic depression in comparison with nonchronic depression using a population-representative national database. Our study used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) to determine the lifetime prevalence and correlates of major depression with chronic symptoms in the population. The CCHS 1.2 is a large, cross-sectional mental health survey conducted by Statistics Canada (n = 36 984, aged 15 years and older). The observed lifetime prevalence of major depression with chronic symptoms was 2.7%, representing 26.8% of all people with major depressive disorder (MDD). In comparison to nonchronic major depression, chronic depression was associated with more frequent psychiatric and medical comorbidity, greater disability, increased health service use, and higher likelihood of suicidal ideation and attempts. Major depression with chronic symptoms is common in the general population, and is associated with more severe health consequences than nonchronic depression. These observations indicate that chronic major depression is a very important subtype of MDD from a public health perspective.

Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis

Background Reviews of the relative efficacy of psychotherapy and combined therapy (psychotherapy with pharmacotherapy) for depression have yielded contradicting conclusions. This may be explained by the clinical heterogeneity of the studies reviewed. Aims To conduct a meta-analysis with an acceptable level of homogeneity in order to investigate the relative efficacy of psychotherapy and combined therapy in the acute treatment of depression. Method A systematic search was performed for RCTs published between 1980 and 2005 comparing psychotherapy and combined therapy in adult psychiatric outpatients with non-psychotic unipolar major depressive disorder. The studies were classified according to the chronicity and severity of the depression. Data were pooled by means of meta-analysis and statistical tests were conducted to measure heterogeneity. Results The meta-analysis included seven studies looking at a total of 903 patients. None of the heterogeneity tests established significance. This indicates a lack of evidence for the heterogeneity of the results. The dropout rates did not differ significantly between the two treatment modalities (25% in combined therapy and 24% in psychotherapy, p = 0.77). At treatment termination, the intention-to-treat remission rate for combined therapy (46%) was better than for psychotherapy (34%) ( p = 0.0007); Relative Risk 1.32 (95% CI: 1.12–1.56), Odds Ratio 1.59 (95% CI: 1.22–2.09). In moderate depression, the difference between the remission rate for combined therapy and psychotherapy was statistically significant (47% compared to 34% respectively, p = 0.001). This was not the case in mild major depression (42% compared to 37% respectively, p = 0.29). The difference was also statistically significant in chronic major depression (48% compared to 32%, p < 0.001), but not in non-chronic major depression (43% compared to 37%, p = 0.22). On a more specific level, no differences were found in the remission rates for the treatment modalities in mild or moderate non-chronic depression. Combined therapy led to significantly better results than psychotherapy in moderate chronic depression only (48% compared to 32%, p < 0.001). Conclusions In the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity and chronicity. Combined therapy outperformed psychotherapy in moderate chronic depression only. No differences were found in mild and moderate non-chronic depression. No data were found for mild chronic depression and for severe depression.

Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis

Abstract We investigated the efficacy of pharmacotherapy and psychotherapy for depression by searching for RCT's. Studies were classified according to chronicity and severity and a meta-analysis was applied. Ten studies were included. Remission did not differ between psychotherapy (38%) and pharmacotherapy (35%). No differences were found in chronic, or in non-chronic depression, and in mild or in moderate depression. Both treatments performed better in mild than in moderate depression. Dropout was larger in pharmacotherapy (28%) than in psychotherapy (24%). At follow-up relapse in pharmacotherapy (57%) was higher than in psychotherapy (27%). Psychotherapy and pharmacotherapy appear equally efficacious in depression. Both treatments have larger effects in mild than in moderate depression, but similar effects in chronic and non-chronic depression and at follow-up psychotherapy outperforms pharmacotherapy. Zusammenfassung Die relative Effizienz von Psychotherapie und Pharmakotherapie bei der Behandlung von ...

Familial Aggregation of Illness Chronicity in Recurrent, Early-Onset Major Depression Pedigrees

The authors used a large sample collected for genetic studies to determine whether a chronic course of illness defines a familial clinical subtype in major depressive disorder. A measure of lifetime chronicity of depressive symptoms (substantial mood symptoms most or all of the time) was tested for familial aggregation in 638 pedigrees from the Genetics of Recurrent Early-Onset Depression (GenRED) project. In subjects with chronic depression, the mean age at illness onset was lower and rates of attempted suicide, panic disorder, and substance abuse were higher than among those with nonchronic depression. Chronicity was assessed in 37.8% of affected first-degree relatives of probands with chronic depression and in 20.2% of relatives of probands with nonchronic depression. Analysis using the generalized estimating equation model yielded an odds ratio of 2.52 (SE=0.39, z=6.02, p<0.0001) for the likelihood of chronicity in a proband predicting chronicity in an affected relative. With stratification by proband age at illness onset, the odds ratio for chronicity in relatives by proband chronicity status was 6.17 (SE=2.09, z=5.35, p<0.0001) in families of probands whose illness onset was before age 13 and 1.92 (SE=0.34, z=3.72, p<0.0001) in families of probands whose illness started at age 13 or later. These findings suggest that chronicity of depressive symptoms is familial, especially in preadolescent-onset illness. Chronicity is also associated with other indicators of illness severity in recurrent, early-onset major depression. Further study using chronicity as a subtype in the genetic analysis of depressive illness is warranted. Refinement of the definition of chronicity in depressive illness may increase the power of such studies.

Familial Aggregation of Illness Chronicity in Recurrent, Early-Onset Major Depression Pedigrees

Objective: The authors used a large sample collected for genetic studies to determine whether a chronic course of illness defines a familial clinical subtype in major depressive disorder. Method: A measure of lifetime chronicity of depressive symptoms (substantial mood symptoms most or all of the time) was tested for familial aggregation in 638 pedigrees from the Genetics of Recurrent Early-Onset Depression (GenRED) project. Results: In subjects with chronic depression, the mean age at illness onset was lower and rates of attempted suicide, panic disorder, and substance abuse were higher than among those with nonchronic depression. Chronicity was assessed in 37.8% of affected first-degree relatives of probands with chronic depression and in 20.2% of relatives of probands with nonchronic depression. Analysis using the generalized estimating equation model yielded an odds ratio of 2.52 (SE=0.39, z=6.02, p<0.0001) for the likelihood of chronicity in a proband predicting chronicity in an affected relative. With stratification by proband age at illness onset, the odds ratio for chronicity in relatives by proband chronicity status was 6.17 (SE=2.09, z=5.35, p<0.0001) in families of probands whose illness onset was before age 13 and 1.92 (SE=0.34, z=3.72, p<0.0001) in families of probands whose illness started at age 13 or later. Conclusions: These findings suggest that chronicity of depressive symptoms is familial, especially in preadolescent-onset illness. Chronicity is also associated with other indicators of illness severity in recurrent, early-onset major depression. Further study using chronicity as a subtype in the genetic analysis of depressive illness is warranted. Refinement of the definition of chronicity in depressive illness may increase the power of such studies.

Marital History and Current Marital Satisfaction in Chronic Depression

Marital functioning is an important consideration in the treatment of depression. Although there are several studies of the marriages of depressed individuals, there is little data on the marital lives of those with chronic depression. In this article, we compare the marital history and marital satisfaction in a sample of carefully diagnosed outpatients with chronic depression compared to those with nonchronic depression. The groups were similar in terms of a history of divorce and for the percentage who had ever been married. However, the chronic group had significantly lower levels of marital satisfaction. Increased attention to marital functioning in this group may be beneficial during treatment.

Clinical and Neuroradiologic Features Associated With Chronicity in Late-Life Depression

The authors conducted a 6-year follow-up of 16 patients with late-life depression to evaluate the relationships between clinical and neuroradiologic variables and disease outcome. Patients had a comprehensive neuropsychiatric evaluation and magnetic resonance imaging (MRI) at baseline and follow-up. Eight of the 16 developed a chronic course of unremitting major depression sufficient to cause significant psychosocial impairment. Six patients with a chronic course and four patients with a non-chronic course of depression had white matter hyperintensities (WMH) on MRI at baseline. Four patients whose WMH increased in size over time developed a chronic unremitting course of depression. No patients with non-chronic depression had large areas of WMH at baseline or exhibited increased WMH size over time. Chronic depression was associated with severity of cerebrovascular risk factors, apathy, and poor quality of life. Treatment and prevention of cerebrovascular disease may improve the outcome of late-life depression.

Chronic depression subtypes: A 257 case study

The aim of the study was to compare Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) three subtypes of chronic depression (chronic major depressive episode [MDE] occurring in major depressive and bipolar II disorders, dysthymic disorder with MDE, and MDE without full interepisode recovery occurring in major depressive and bipolar II disorders) with each other, and with nonchronic depression, and to find if this subdivision was supported by clinical data. Two hundred and fifty seven consecutive MDE outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning (GAF) scale. Clinical variables (age, age at onset, duration of illness, severity, gender, recurrences, atypical and psychotic features, axis I comorbidity, bipolar II, and unipolar diagnoses) were compared among the chronic depression subtypes, and versus nonchronic depression. Chronic MDE had significantly less comorbidity than the other two chronic depression subtypes. All the other variables were not significantly different. Chronic depression subtypes had significantly longer duration of illness, less comorbidity, and more recurrences than nonchronic depression. These findings do not support the DSM-IV subtyping of chronic depression.

Chronic depression subtypes: A 257 case study

The aim of the study was to compare Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) three subtypes of chronic depression (chronic major depressive episode [MDE] occurring in major depressive and bipolar II disorders, dysthymic disorder with MDE, and MDE without full interepisode recovery occurring in major depressive and bipolar II disorders) with each other, and with nonchronic depression, and to find if this subdivision was supported by clinical data. Two hundred and fifty seven consecutive MDE outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning (GAF) scale. Clinical variables (age, age at onset, duration of illness, severity, gender, recurrences, atypical and psychotic features, axis I comorbidity, bipolar II, and unipolar diagnoses) were compared among the chronic depression subtypes, and versus nonchronic depression. Chronic MDE had significantly less comorbidity than the other two chronic depression subtypes. All the other variables were not significantly different. Chronic depression subtypes had significantly longer duration of illness, less comorbidity, and more recurrences than nonchronic depression. These findings do not support the DSM-IV subtyping of chronic depression. Depression and Anxiety 10:81–84, 1999. © 1999 Wiley-Liss, Inc.