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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The definition of chronic depression necessarily calls for a review of the concept of recovery which in psychopathology is not clearly and univocally defined. The percentage of chronic evolution among depressive patients either as a persistence of depressive symptoms or as an impairment of social and professional role, ranges from 12 to 15%. Chronic depression raises psychopathologic and nosographic problems as well as clinical ones. In fact chronic depressives are often not correctly diagnosed, inadequately treated and destined to be affected by an over increasing inability. The chronic evolution of depression may result as a concurrence of several factors: a neurotic personality, an inadequate antidepressant maintenance treatment, an inappropriated use of minor tranquillizers as the only treatment. The occurrence of physical impairement, the continuous nature of depression and the resistance of antidepressant treatment may be also considered. Moreover the psychodynamic mechanisms aroused by the depressive experience and the secondary advantages of the illness may plan an effective role maintaining depressive symptomatology.
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PMID:[Chronic depressions (author's transl)]. 54 67

Depressive symptoms in a population (N = 419) aged 65 years or over and receiving home nursing, home help or both were assessed by postal questionnaires including the Zung self-rating depression scale (SDS). Eighty-six percent participated, and 38 percent of both men and women scored 45 raw sumpoints or more in the SDS. The mean of the raw sumpoints was 42.1 (+/- 9.6) for men (N = 100) and 41.4 (+/- 9.0) for women (N = 238, the difference being nonsignificant. Home help clients scored less than home nursing patients or patients receiving both home nursing and home help. The population scoring 45 raw SDS sumpoints or more was investigated by a general practitioner, and the diagnosis of depression was made according to DSM III-criteria. The clinical investigations showed 26 percent of both men and women who participated to be depressive. Chronic depression was the most common class, followed by atypical depression. About two thirds of the depressive men and half of the depressive women were 'new' cases in that it had not been realized earlier that they suffer from depression. Atypical depression was the class where underdiagnozing was most evident. Among elderly men psychomotor retardation, libido loss, anorexia and indecisiveness and among elderly women psychomotor retardation, indecisiveness, emptiness and diurnal variation were common symptoms of depression.
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PMID:Prevalence of depressive symptoms and depression in elderly Finnish home nursing patients and home help clients. 348 70

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.
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PMID:A preliminary report on defenses and conflicts associated with borderline personality disorder. 381 6

A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes. Symptom severity was assessed by the 17-item Hamilton Rating Scale for Depression. Chronic depression was defined as the current episode of major depression lasting at least 2 years, corresponding to DSM-III-R and -IV criteria. Patients with chronic depression (n = 64) were compared with those with nonchronic depression (n = 179). Chronicity was not related to gender, symptom severity, prior length of illness, age at onset of illness, RDC endogenous/nonendogenous, RDC primary/secondary or Winokur's family-history subtypes. Those with chronic depression were older and had fewer major depressive episodes than the nonchronic group. That the chronic group had fewer total episodes of depression than the nonchronic group, but a similar age at onset, is consistent with the notion that patients in a current chronic episode have characteristically longer depressive episodes throughout the course of their illness. Those with chronic episodes may be subject to psychological, biological and/or sociocultural factors that preclude an earlier episode remission for these individuals.
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PMID:Clinical characteristics of outpatients with chronic major depression. 762 36

Chronic depression actually covers several different nosographic entities. Among the predictive factors for chronicity, personality disorders raise the complex issue of the relationship between traits and depression. Some approaches favour the concept of premorbid personality, others in contrast insist more on personality disorders which complicate a depressive episode. In order to account for both stress factors and biological factors in the progression of depression towards chronicity, Post suggested in 1992 a bold integrative pattern. In this pattern, the premorbid period would be marked by secondary sensitization to repeated stress factors. These factors would cause not only short-term but also longer-term fragility by modifying the transcription of protein encoding, in particular for the C-fos oncogene. This would cause peptide alterations which originate a vulnerability to mood disorders. With time, an accumulation mechanism and a kindling phenomenon would cause the initial depressive episode to develop, and that in turn would constitute a new vulnerability factor for the new spontaneous occurrence of further depressive episodes. This model has the merit to underline the importance of early and durable treatment. It also suggests a promising approach for the future.
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PMID:[Introduction to chronic depression and resistant depression]. 828 3

Can depression still be defined today as a transient abnormal state which is reversible with treatment? Chronic depression affects about one out of five depressed subjects. The progression to chronicity has a multifactorial determinism; it includes sociodemographic, medical and psychopathological parameters. These depressions are sometimes difficult to diagnose, all the more as there are no definitely established nosographic criteria. One usually considered is the persistence over more than two years of depressive symptoms and/or of socioprofessional dysfunctions. First-line treatment is based on uninterrupted prescription of a well-tolerated antidepressant for over two years, with dosage maintained at the acute phase level. In the event of a failure, there is as yet no well-defined alternative therapy. Because of their socioprofessional repercussions, chronic depressions may become a significant public health issue. They need imperiously that prospective long-term evaluation studies be implemented.
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PMID:[Chronic depression and its treatment]. 828 5

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.
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PMID:Clinical and neuroradiologic features associated with chronicity in late-life depression. 1052 Nov 63

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.
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PMID:Chronic depression subtypes: a 257 case study. 1056 32

Chronic depression, which is marked by a course of illness lasting 2 years or more, encompasses 4 subtypes of depressive illness: (1) chronic major depressive disorder, (2) dysthymic disorder, (3) dysthymic disorder with major depressive disorder ("double depression"), and (4) major depressive disorder with poor interepisodic recovery (i.e., in incomplete remission). In the 1990s, chronic depression had a reported prevalence rate of 3% to 5% and accounted for 30% to 35% of all cases of depression in the United States. The authors present an algorithm modified from the Texas Medication Algorithm Project for patients with chronic depression. This treatment algorithm recommends a progression of steps or stages in treating chronic depression. The first stage is monotherapy with the selective serotonin reuptake inhibitors, nefazodone, bupropion sustained release, venlafaxine extended release, mirtazapine, or psychotherapy. Later options include combination therapy, electroconvulsive therapy, atypical antipsychotics, and novel treatments. Utilization of a comprehensive treatment algorithm for chronic major depression should encourage efficient, efficacious treatment.
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PMID:Algorithm for the treatment of chronic depression. 1131 Aug 16

Chronic depression represents an important public health concern for women. It is underrecognized and undertreated and is associated with significant functional impairment and high rates of comorbidity. Moreover, recent research suggests that chronic depression may affect women more seriously than men; for example, women may experience illness onset at an earlier age and experience more severe psychosocial impairment compared with men. Recent studies have demonstrated the efficacy of both antidepressant medications and psychotherapy in treating chronic depression, with differential responsiveness to some treatments between women and men. Young women should be screened carefully and treated vigorously to prevent the serious consequences of this condition.
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PMID:Chronic depression in women. 1214 19


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