持续性抑郁症被定义为一种慢性疾病,即便在较温和的情况下(例如,心境恶劣),也通常伴有复发性重性抑郁发作。在其他情况下,持续性抑郁症患者也可能患有慢性重性抑郁。经过治疗,该疾病可得到缓解,心理社会功能可显著改善。抑郁患者的自杀率很高,但持续性抑郁症患者的精确自杀率尚不清楚。持续性抑郁症通常共患精神疾病,例如,焦虑障碍和物质滥用,且与显著的功能障碍有关联(包括失业、难以建立亲密关系、医疗服务利用率更多、公共福利利用率更大等)。[18]Angst J, Gamma A, Rössler W, et al. Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. J Affect Dis. 2009;115:112-121.http://www.ncbi.nlm.nih.gov/pubmed/18973954?tool=bestpractice.com[19]Hellerstein DJ, Agosti V, Bosi M, et al. Impairment in psychosocial functioning associated with dysthymic disorder in the NESARC study. J Affect Disord. 2010;127:84-88.http://www.ncbi.nlm.nih.gov/pubmed/20471093?tool=bestpractice.com[92]Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA. 1989;262:914-919.http://www.ncbi.nlm.nih.gov/pubmed/2754791?tool=bestpractice.com
治疗效果
与较为抑郁急性期患者相比,持续性抑郁症的治疗需要更长的时间才能显示效果。尚没有单纯心境恶劣长期研究的报告。慢性重性抑郁研究显示,长期治疗(2-3 年或更长时间)很可能减少复发。[27]Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:1462-1470 [Erratum in: N Engl J Med. 2001;345:232].http://www.nejm.org/doi/full/10.1056/NEJM200005183422001#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/10816183?tool=bestpractice.com[93]Keller MB, Kocsis JH, Thase ME, et al. Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial. JAMA. 1998;280:1665-1672.http://jama.ama-assn.org/cgi/content/full/280/19/1665http://www.ncbi.nlm.nih.gov/pubmed/9831997?tool=bestpractice.com
自杀
持续性抑郁症患者的自杀率尚不清楚,但很可能比一般人群高,因为持续性抑郁症是一种慢性且通常使人功能减退的疾病。