Dysthymia and the Spectrum of Chronic Depressions

This valuable collection of chapters places the last 15 years of affective disorder research and clinical practice in a wonderful perspective. Although most of these chapters were directly derived from a conference held in Spoleto, Italy, in 1992, the distinguished group of contributors provide a lively debate on nosological and treatment issues, a debate that continues to this date. Given the interest and expertise of Akiskal and Cassano, the debate focuses on the chronic depressive disorders. The authors review the historical classic roots and changes in the conceptual framework of chronic and “minor” depressive disorders, driven by empirical diagnostic and treatment data, and conclude that the present nomenclature can embrace the spectrum and chronic conditions better than has been done previously. The authors consider their own clinical research and practice experiences in the United States, Brazil, Canada, England, and Germany and conclude that dysthymia, chronic major depression, and residual depressive states are here to stay, have reliable diagnostic criteria, and are amenable to psychopharmacological intervention. For example, it is argued that concurrent personality “clusters” or disorders do not diminish the likelihood of positive responses to pharmacotherapy in chronic depressive conditions. A number of other depressive subtypes are discussed, such as minor and recurrent brief depression, “chronic fatigue,” atypical depression, “hysteroid” dysphoria, and two “childhood” conditions—chronic depression in childhood and concurrent depression with attention deficit hyperactivity disorder. Perhaps the most interesting debate occurs on the importance of neurotic depression: Roth and Mountjoy argue for the concept on one side and Maj argues on the other side.

In editing the volume, Akiskal and Cassano have kept the number of redundant chapters to a minimum, enabling the reader to use it as a valuable resource. As mentioned at the outset, this volume sets the stage for the last 5 years by giving the reader a superb snapshot of circa 1992. We could use the second volume now for the update because numerous clinical trials have demonstrated that the editors and authors were quite accurate in their prognosis—that these conditions can be well treated both for the short and the long term. Indeed, one might argue that the reader would benefit from a concluding chapter outlining the advances based on new clinical trial findings. Perhaps the next volume is being prepared now so we can place it on our shelves next to the present one.