[Chronic depression and its treatment]

Can depression still be defined today as a transient abnormal state which is reversible with treatment? Chronic depression affects about one out of five depressed subjects. The progression to chronicity has a multifactorial determinism; it includes sociodemographic, medical and psychopathological parameters. These depressions are sometimes difficult to diagnose, all the more as there are no definitely established nosographic criteria. One usually considered is the persistence over more than two years of depressive symptoms and/or of socioprofessional dysfunctions. First-line treatment is based on uninterrupted prescription of a well-tolerated antidepressant for over two years, with dosage maintained at the acute phase level. In the event of a failure, there is as yet no well-defined alternative therapy. Because of their socioprofessional repercussions, chronic depressions may become a significant public health issue. They need imperiously that prospective long-term evaluation studies be implemented.