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According to the World Health Organization, 300,000,000 people suffer from depression, and by 2020, depression will be the second most common disease. Already, statistics indicate that half of all people who go through a first episode of depression will experience a second episode. One-half of all patients diagnosed
with Major Depressive Disorder become chronic; 20% do not react to antidepressant medication, and another 20% experience only short-term relief from it. Relapse rates following all forms of short-term therapy are high.
The German Psychoanalytic Association (Sigmund-Freud-Insti-tute in Frankfurt) undertook an outcome study on long-term psychoanalytic treatment with chronically depressed patients; the results suggest that psychoanalysis or long-term psychoanalytic psychotherapy is the therapy of choice. Eighty percent of previously depressed patients (who also suffered from severe personality disorders, anxious neurotic symptoms, or psychosomatic symptoms) showed stable improvement of their depressive symptoms, their enjoyment of life, their work, and their personal relationships following long-term psychoanalytic therapy.
Similar results have been reported from a prospective study in Stockholm, Heidelberg, and Munich: the higher the frequency of sessions, the more stable the results of treatment. Results like these seem to indicate that high-frequency, long-term treatments lead to better and longer-lasting results than low-frequency, psychody-namic, short-term therapies.
Psychoanalytic views of depression describe developmental failure caused by conflicts and unconscious fantasies, contributing to an unrealistic sense of self and identity, as well as to the incapacity to engage in and maintain mutually satisfying object relationships. The complexity of individual and transgenerational determinants of chronic depression itself suggests that short cognitive-behavioral therapies cannot effect fundamental change of the multilayered unconscious determinants of