[The way to remission from chronic depression: a psychopathological consideration]

In this report, we discuss the possibility of recovery from chronic depression from the psychopathologic viewpoint. In clinical practice, it is important to treat carefully the recovering process as well as not to dismiss the bipolarity, in order to prevent prolongation of the depression. We should consider the recovering process not as a mere interval preceding the remission, but an independent phase marked by a certain instability between two stable stages, severe depression and normal mental state. It is characterized by the psychopathology of the criticality, in which clinical meaning of a phenomenon could not determined univocally, varying from an extreme to another depending on therapeutic parameters. We propose some clinical devices to the chronic depression, defining its psychopathology as a diffuse dissemination of the criticality of the recovering process. As to general matter, it is necessary to switch therapeutic strategy for the acute stage to that proper to chronic period, maintaining the sick role on the patient. For the physiological treatment, stabilization of mood swing and regulation of circadian rhythm have priority over elevation of mood. Finally we discuss on the psychotherapeutic problems. On the one hand, chronic depressive patients have to liberate them from their narcissistic object relationship to establish autonomic ego. On the other hand, the therapist has to recognize that their depression has a certain truth on human being itself, to give them back the meaning of the disease.