Dysthymia and Chronic Major Depression

This chapter reviews epidemiology, diagnostic criteria, societal burden, treatment efficacy, and clinical recommendations for two forms of chronic depression, specifically, dysthymic disorder and chronic major depression. Comparisons of individuals with different presentations of chronic depression have revealed few differences in demographic, clinical, and familial characteristics, or in treatment response. However, comparisons of nonchronic versus chronically depressed samples indicate substantial differences with higher levels of comorbidity, prevalence of child adversity, parental psychopathology, and societal burden among those with chronic forms of depression. The chapter reviews findings on treatments for chronic major depression and dysthymic disorder, including cognitive behavioral therapy, interpersonal therapy, cognitive behavioral analysis system of psychotherapy, pharmacotherapy, and combined treatment. It is argued that the length of treatment trials to date lacks empirical basis and does not reflect the long-term nature of the illness. Treatment recommendations specific to chronic forms of depression are discussed. Keywords: epidemiology of chronic depression; economic burden; cognitive behavior therapy; CBT; interpersonal therapy; IPT; cognitive behavioral analysis system of psychotherapy; CBASP; combined treatment