The spectra of neurasthenia and depression: course, stability and transitions

Abstract

j Abstract Background Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood. Methods In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account. Results The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low. Conclusions Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.

Prevalence and Correlates of Prolonged Fatigue in a U.S. Sample of Adolescents

“…Indeed, studies of community samples of adults reveal that 44%-75% of persons with prolonged fatigue report comorbid anxiety or depressive disorders (1,3,4). Whereas ICD includes a category for neurasthenia, DSM does not recognize prolonged fatigue as a distinct entity (1,11).…”

Two-week neurasthenic major depression

“…In total, 44 (68.5 %) of 64 subjects who ever reported 3-month neurasthenia also reported major depressive episodes (OR = 4.5). The strong association between the two diagnoses was also confirmed by a longitudinal analyses with a GEE model [6].…”

“…The methodology of the Zurich Study was described in detail in an earlier paper [6]. The study is based on the SPIKE interview which includes a separate section on neurasthenia.…”

Comorbidity of depression and nonaffective — schizophrenia spectrum disorders: the clinical-epidemiological study EDIP

“…При эмоционально-гиперестетических расстрой-ствах (астения, неврастения) частота коморбидной депрессии оценивается в 53-79% [18,19]. В то же время у пациентов с депрессией неврастения реги-стрируется в 22,9% наблюдений [19].…”

“…В то же время у пациентов с депрессией неврастения реги-стрируется в 22,9% наблюдений [19]. В свою оче-редь, по данным крупных когортных и близнецовых исследований, перенесенная в течение жизни де-прессия повышает шанс развития неврастении в 4,5 раза (ОШ=4,5, 95% ДИ 2,5-7,9) [19], а наличие хотя бы одного депрессивного эпизода в анамнезе значи-мо ассоциировано с показателями астении -«ано-мальная усталость» (ОШ=3,19, 95% ДИ 2,64-3,84) и «длительная усталость» (ОШ=6,47, 95% ДИ 3,36-12,47) на момент обследования [20].…”