Abstract

As shown in this volume and others in this series, it is untenable nowadays to regard depression as a unidimensional phenomenon in terms of diagnosis and treatment. The notion of complex depression is closer to the clinical-etiological reality of the disorder and also provides a clearer impression of what professionals must deal with in highly demanding settings, including primary care (PC). This is especially true in low-medium-income countries (LMICs), where patients with complex depression are often likened to those who mental health practitioners call “difficult patients.” From this perspective, the present chapter addresses complex depression and highlights its heterogeneous nature, marked by the functioning of patients’ personality structure, depressive experience style, suicide risk, contextual factors, and medical comorbidities that have an impact on their response to treatment. After discussing how the treatment context and the characteristics of the professionals who treat these patients interact with the aforementioned factors, we present a model for the psychotherapeutic management of complex depression in high-demand settings, with an emphasis on the handling of personality dysfunctions.