New strategies for treating chronic depression.

This article provides an update on the diagnosis of chronic depression subtypes, the clinical and public health significance of chronic depression, and a review of what is known about its treatment. The efficacy of antidepressant medications for pure dysthymia and double depression has been established, yet fewer than 50% of patients have achieved full remission with a single agent. Traditional antidepressant psychotherapies appear to have limited effectiveness for chronic depression. In one recent study, a combination of cognitive behavioral analysis system of psychotherapy and a newer antidepressant, nefazodone, yielded the highest response and remission rates ever reported in this population (73% response rate, 48% remission rate in an intent-to-treat sample). This combination merits further study for treatment of chronic depression.