Chronic depression

NICE have defined chronic depression in the guideline on management of depression (1).

• diagnosed when a person meets the diagnostic criteria for depression for at least 2 years
• patients may require combination treatments and attention to social and support factors that may maintain or ameliorate their difficulties
  • may require rehabilitation to help them regain confidence to return to more independent living. People who have had severe or chronic depression may require special help in returning to work. Work provides a number of protective factors for depression including structure to a day, social contacts and self-esteem
• should be offered a combination of CBT and antidepressant medication
• for male patients with chronic depression who have not responded to an SSRI, consideration should be given to a tricyclic antidepressant because men tolerate the side effects of tricyclic antidepressants reasonably well
• people with chronic depression who would benefit from additional social support, befriending should be considered as an adjunct to pharmacological or psychological treatments

For more detailed guidance then refer to full NICE guideline (1).

Reference:

1. NICE (December 2004). Management of depression in primary and secondary care.