Chronic depression.

Recent research has enabled clinicians to reclassify many patients who formerly were diagnosed as having personality disorders as instead suffering from chronic depression. The American Psychiatric Association now recognizes two subtypes of such depression: (1) residual (partly remitted) major depression and (2) dysthymia. As a result of these developments, an increasing number of psychiatrists now treat selected chronically depressed patients with full trials of a broad range of thymoleptic agents, thus alleviating the suffering of many patients who had previously been deemed refractory. The author summarizes his research efforts to establish the clinical legitimacy of chronic depression and suggests that supportive psychotherapeutic and psychoeducational approaches can enhance the therapeutic gains achieved through pharmacotherapy.