The Biology of Chronic Depression

  • James H. Kocsis
Part of the The Depressive Illness Series book series (DISS, volume 4)


A dramatic shift has occurred in the conceptualization of chronic depressions by clinical psychiatrists over the past decade. Prior to 1980 chronic depressions, particularly those with onset at an early age, were usually regarded as “personality disorders” or “neuroses” and were either treated by psychotherapy or left untreated altogether. In 1980 the new official nomenclature of the American Psychiatric Association (DSM-III) designated chronic depressive states under the term Dysthymic Disorder and placed this category in the Affective Disorders section of that nosology. This served to emphasize the possible association between chronic depression and affective illness, and to stimulate research on the pharmacology of chronic depression. Several reports have now been published describing positive responses of patients with chronic “characterologic” depression or Dysthymic Disorder to treatment with thymoleptic medications (Akiskal et al., 1980; Paykel et al., 1982; Harrison et al., 1986; Vallejo et al., 1987; Kocsis et al., 1988a, b). These developments have influenced the thinking and the practice of clinical psychiatry. Clinicians are now much more likely to view chronic or “lifelong” depressions as a form of affective illness and to prescribe adequate trials of antidepressant medication for treatment of these conditions.


Major Depression Affective Disorder Dexamethasone Suppression Test Chronic Depression Dysthymic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Akiskal HS: Dysthymic disorder: Psychopathology of proposed chronic depressive subtypes. Am J Psychiatry 1983; 140: 11–22.PubMedGoogle Scholar
  2. Akiskal HS, Rosenthal TL, Haykal RF, Lemmi H, Rosenthal RH, Scott-Strauss A: Characterologic depressions: clinical and sleep EEG findings separating “sub-affective dysthymias” from “character spectrum disorders.” Arch Gen Psychiatry 1980; 37: 777–783.PubMedCrossRefGoogle Scholar
  3. Akiskal HS, King D, Rosenthal TL, Robinson D, Scott-Strauss A: Chronic depressions: Clinical and familial characteristics in 137 probands. J Affect Disord 1981; 3: 297–315.PubMedCrossRefGoogle Scholar
  4. Andreasen NC, Endicott J, Spitzer RL, Winokur G: The family history method using diagnostic criteria: Reliability and validity. Arch Gen Psychiatry 1977; 34: 1229–1235.PubMedCrossRefGoogle Scholar
  5. Harrison W, Rabkin J, Stewart JW, McGarth PJ, Tricamo E, Quitkin F: Phenelzine for chronic depression: A study of continuation treatment. J Clin Psychiatry 1986; 47: 436–449.Google Scholar
  6. Jarrett DB, Miewald JM, Kupfer DJ: Recurrent depression is associated with apersistent reduction in sleep-related growth hormone secretion. Arch Gen Psychiatry 1990; 47: 113–118.PubMedCrossRefGoogle Scholar
  7. Hauri P, Sateia MJ: REM sleep in dysthymic disorders. Sleep Res 1984; 13: 119.Google Scholar
  8. Keller M, Shapiro RW: “Double depression”: Superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry 1982; 139: 438–442.PubMedGoogle Scholar
  9. Keller MB, Lavori PW, Endicott J, Coryell W, Klerman GL: “Double depression”: Two-year follow-up. Am J Psychiatry 1983; 140: 689–694.PubMedGoogle Scholar
  10. Klein DF, Davis JM: Diagnosis and Treatment of Psychiatric Disorders. Baltimore: Williams & Wilkins, 1969.Google Scholar
  11. Klein DN, Taylor EB, Dickstein S, Harding K: The early-late onset distinction in DSM-III-R dysthymia. J Affective Disord 1988a; 14: 25–33.CrossRefGoogle Scholar
  12. Klein DN, Taylor EB, Kickstein S, Harding K: Primary, early-onset dysthymia: Comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome. J Abnormal Psychol 1988b; 97: 387–398.CrossRefGoogle Scholar
  13. Klein DN, Clark DC, Kansky L, Margolis ET: Dysthymia in the offspring of parents with primary bipolar affective disorder. J Abnormal Psychol 1988c; 97: 265–274.CrossRefGoogle Scholar
  14. Kocsis JH, Frances AJ: A critical discussion of DSM-III dysthymic disorder. Am J Psychiatry 1987; 144: 1534–1542.PubMedGoogle Scholar
  15. Kocsis JH, Frances AJ, Voss C, Mann JJ, Sweeney J: Imipramine treatment for chronic depression. Arch Gen Psychiatry 1988a; 45: 253–257.PubMedCrossRefGoogle Scholar
  16. Kocsis JH, Frances AJ, Voss C, Mason BJ, Mann JJ, Sweeney J: Imipramine and social-vocational adjustment in chronic depression. Am J Psychiatry 1988b; 145: 997–999.PubMedGoogle Scholar
  17. Kocsis JH, Mason BJ, Frances AT, Sweeney J, Mann JJ, Marin D: Prediction of response of chronic depression to imipramine. J Affective Disord 1989; 17: 255–260.CrossRefGoogle Scholar
  18. Loosen PT, Prange AJ: Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: A review. Am J Psychiatry 1982; 139: 405–416.PubMedGoogle Scholar
  19. Miller IW, Norman WH, Dow MG: Psychosocial characteristics of “doubledepression.” Am J Psychiatry 1986; 143: 1042–1044.PubMedGoogle Scholar
  20. Mitchell PB, Beam JA, Corn TH, Checkley SA: Growth hormone response to clonidine after recovery in patients with endogenous depression. Br J Psychiatry 1988; 152: 34–38.PubMedCrossRefGoogle Scholar
  21. Paykel ES, Rowan PR, Parker RR, Bhat AV: Response to phenelzine and amitriptyline in subtypes of outpatient depression. Arch Gen Psychiatry 1982; 39: 1041–1049.PubMedCrossRefGoogle Scholar
  22. Petty LK, Asarnow JR, Carlson GA, Lesser L: The dexamethasone suppression test in depressed, dysthymic and nondepressed children. Am J Psychiatry 1985; 142: 631–633.PubMedGoogle Scholar
  23. Roy A, Sutton M, Pickar D: Neuroendocrine and personality variables in dysthymic disorder. Am J Psychiatry 1985; 142: 94–97.PubMedGoogle Scholar
  24. Vallejo J, Gasto C, Catalan R, Salermo M: Double-blind study of imipramine versus phenelzine in melancholias and dysthymic disorders. Br J Psychiatry 1987; 151: 639–642.PubMedCrossRefGoogle Scholar
  25. Weissman MM, Merikangas KR, John; K, Wickramaratne P, Prusoff PS, Kidd KK: Family-genetic studies of psychiatric disorders: Developing technologies. Arch Gen Psychiatry 1986; 43: 1104–1116.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • James H. Kocsis
    • 1
  1. 1.New York HospitalCornell Medical CenterNew YorkUSA

Personalised recommendations