Endogenous, Reactive and Neurotic Depression – Diagnostic Stability and Long-Term Outcome

Abstract

Background: No larger long-term study has been conducted of outcomes of patients diagnosed with endogenous, reactive or neurotic depression and using survival methods in the analyses. Sampling and Methods: All patients who had had their first-ever discharge in the period from 1970 to 1994 with a diagnosis of endogenous, reactive or neurotic depression according to ICD-8 were identified in a nationwide register of admissions to psychiatric wards. Patients were followed up to 1999 and the long-term diagnostic stability, the risk of relapse leading to readmission and the risk of suicide was analysed in the three groups. Results: The diagnostic stability over time of the diagnosis of reactive depression and neurotic depression was low. Patients with neurotic depression had a substantially greater risk of relapse leading to readmission compared to patients with endogenous depression, and patients with reactive depression had less risk of relapse. No differences were found in the risk of completed suicide between the three groups of patients during long-term follow-up. Conclusions: The study does not provide evidence for re-establishing prior diagnostic systems of depressive disorders based on the presence or absence of neurotic characteristics or on the presence or absence of a psychic trauma as in ICD-8.

Depression: Discrete or Continuous?

“…If there are different types of depression, then the answer is extremely complicated with separate dimensions for each type. However, as we have seen, evidence does not support there being truly discrete forms [1,2,3,4,5,6,7,15,16,17,18,19,20,21,22]. Ironically, evidence for a unitary dimension of depression severity actually comes from research used to support a discrete type of depression - melancholic/endogenous.…”

“…Research, however, does not clearly distinguish endogenous/melancholic and reactive/neurotic depression based on these parameters [1,2,3,4,5,6,7,15,16,17,18,19,20,21,22], nor has research supported dysthymia (and its continuation as persistent depressive disorder in DSM-5) and minor depression as distinct forms of depression [23,24,25]. No clear differences in etiology for the various types of depression proposed have been identified that hold out over repeated studies.…”

“…Regarding course, research examining various indicators, such as risk of relapse, likelihood of recurrence, probability of readmission, and suicide, has overall failed to distinguish the two types of depression, with studies yielding varying results [6,19,20,21,22]. For example, Kessing [6] did not find any differences in completed suicide, an important indicator of course.…”

“…For example, Kessing [6] did not find any differences in completed suicide, an important indicator of course. Furthermore, the course and symptom profile of depression often changes over time, fulfilling criteria for various subtypes including major, minor, and dysthymic depression [4,26,27,28].…”

“…One of the key issues is whether depression occurs as discrete types or exists on a continuum [1,2,3,4,5]. Various discrete forms of depression have been identified but have not been proven to represent valid entities [1,2,3,4,5,6,7]. Some of the more common types that have been proposed include endogenous/melancholic, major, minor, reactive/neurotic, and dysthymic.…”