Establishing a diagnosis of depressive disorder in its chronic form implies the existence of several depressive episodes. The states of irritability, sadness, melancholy, sleep-wake cycle disturbances, fatigue, and pronounced impairment of social and personal life are present and represent signs and symptoms of major depressive episodes. A major depressive episode may be difficult to detect due to comorbidity with other medical conditions such as diabetes, morbid obesity, cardiovascular disease, and the socio-cultural context in which the individual functions (DSM-5, 2013).

A psychiatric investigation is required in the case of depressive disorder and medication is often needed and even more so, essential in sustaining psychotherapy. Also, suicide risk assessment is mandatory to address, especially when patients report suicidal thoughts or suicidal tendencies (Oquendo, et al., 2004). To a large extent, it is important to note that the success of therapy depends on the patient's willingness to cooperate.