[Reflections on the management of dysthymia and chronic depression]

The authors points out the more and more commonly admitted importance of mood disturbances that do not result from major dysthymic states, whether from dysthymies or depressives personalities. He notices that the treatment of such states according to an almost general consensus requires a prescription for a very long anti-depressive treatment. He underlines the problems that can be caused by a long intake of medicines, from a theoretical point of view, concerning psychopathologic reference models as well as from a practical point of view concerning the observance of medicine intake. He suggests some therapeutic axes. Concerning chemotherapy, he suggests choosing a molecule with a serotoninergic tropism that is well tolerated and favours intra-psychic elaboration as well as respects cognitive potentialities. From a therapeutic point of view, he recommends a support that avoids excessive mentalisation, blabbering and obsessive harking but that on the contrary favours the expression of the affect and the shifting of representations on the widened model of psychotherapy inspired by psychoanalysis.