[1][2] McCullough writes that chronic depression (i.e., depressive disorder in adults that lasts continuously for two or more years, or one year continuously in adolescents), particularly the type beginning during adolescence (early-onset), is essentially a refractory mood disorder arising from traumatic experiences or interpersonal psychological insults delivered by the patient's significant others (nuclear or extended family).
Whether the etiology includes sudden trauma or psychological insults, the predominant coping strategy that maintains the dysphoric mood condition is an interpersonal avoidance of persons in the home, at work, or in the social environment.
In such a psychosocial functioning state, these individuals remain helpless and hopeless and continue to respond to themselves in a solitary and never-ending circle of pain, fear, anxiety (and depression); hence, they are unable to connect with their interpersonal world in any informing way.
CBASP clinicians enact a "disciplined personal involvement role" to heal the injurious interpersonal traumas and psychological insults patients have received at the hands of harmful significant others.
The Serzone findings roughly correspond with many other trial results for antidepressants, and underscore a major weakness in these drugs—that while they are effective, the benefit is often marginal and the treatment outcome problematic.
The authors of the frequently cited study noted that "the rates of response and remission in the combined-treatment group were substantially higher than those that might have been anticipated on the basis of the outcomes of previous trials in similar patients."