Melancholic and reactive depression: a reappraisal of old categories

BMC Psychiatry

Masaru Mimura²  Hiroki Kocha²  Koichiro Watanabe²  Hiroyuki Uchida²  Toshiaki Kikuchi¹  Hiroyoshi Takeuchi²  Tatsuichiro Takahashi²  Genichiro Tachino²  Sachiko Noda²  Nobuhiro Nagai²  Eisaku Mutsumoto²  Atsumi Minamisawa²  Shinya Koide²  Natsuko Kodashiro²  Asako Serizawa²  Chisa Ozawa²  Kadunari Yoshida²  Hideaki Tani²  Masaki Shinfuku²  Yuya Mizuno²  Hitoshi Sakurai²  Jin Mizushima² 

[1] Zama Mental Clinic, 5-1684-3 Iriya, Zama-shi, Kanagawa 252-0024, Japan;Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

关键词: Reactive depression;    Newcastle scale;    Melancholic depression;    Diagnosis;    Antidepressant;   

Others  :  1123885
DOI  :  10.1186/1471-244X-13-311

 received in 2013-04-25, accepted in 2013-11-14,  发布年份 2013

【 摘 要 】

Background

The dominant diagnostic model of the classification of depression today is unitarian; however, since Kurt Schneider (1920) introduced the concept of endogenous depression and reactive depression, the binary model has still often been used on a clinical basis. Notwithstanding this, to our knowledge, there have been no collective data on how psychiatrists differentiate these two conditions. We therefore conducted a survey to examine how psychiatrists in Japan differentiate patients with major depressive disorder who present mainly with melancholic features and those with reactive features.

Methods

Three case scenarios of melancholic and reactive depression, and one-in-between were prepared. These cases were designed to present with at least 5 symptoms listed in the DSM-IV-TR with severity being mild. We have sent the questionnaires regarding treatment options and diagnosis for those three cases on a 7-point Likert scale (1 = “not appropriate”, 4 = “cannot tell”, and 7 = “appropriate”). Five hundred and two psychiatrists from over one hundred hospitals and community clinics throughout Japan have participated in this survey.

Results

The melancholic case resulted significantly higher than the reactive case on either antidepressants (mean ± SD: 5.9 ± 1.2 vs. 3.6 ± 1.7, p < 0.001), hypnotics (mean ± SD: 5.5 ± 1.1 vs. 5.0 ± 1.3, p < 0.001), and electroconvulsive therapy (mean ± SD: 1.5 ± 0.9 vs. 1.2 ± 0.6, p < 0.001). On the other hand, the reactive case resulted in significantly higher scores compared to the melancholic case and the one- in-between cases in regards to psychotherapy (mean ± SD: 4.9 ± 1.4 vs. 4.3 ± 1.4 vs. 4.7 ± 1.5, p < 0.001, respectively). Scores for informing patients that they suffered from “depression” were significantly higher in the melancholic case, compared to the reactive case (mean ± SD: 4.7 ± 1.7 vs. 2.2 ± 1.4, p < 0.001).

Conclusions

Japanese psychiatrists distinguish between major depressive disorder with melancholic and reactive features, and thus choose different treatment strategies regarding pharmacological treatment and psychotherapy.

【 授权许可】

   
2013 Mizushima et al.; licensee BioMed Central Ltd.

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