Melancholic and reactive depression: a reappraisal of old categories

BMC Psychiatry

Research Article

Natsuko Kodashiro¹  Nobuhiro Nagai¹  Hiroki Kocha¹  Jin Mizushima¹  Asako Serizawa¹  Shinya Koide¹  Chisa Ozawa¹  Yuya Mizuno¹  Tatsuichiro Takahashi¹  Koichiro Watanabe¹  Hideaki Tani¹  Hiroyuki Uchida¹  Masaki Shinfuku¹  Genichiro Tachino¹  Hitoshi Sakurai¹  Hiroyoshi Takeuchi¹  Atsumi Minamisawa¹  Masaru Mimura¹  Kadunari Yoshida¹  Eisaku Mutsumoto¹  Sachiko Noda¹  Toshiaki Kikuchi² 

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

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

DOI  :  10.1186/1471-244X-13-311

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

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsThree 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.ResultsThe 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).ConclusionsJapanese 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】

CC BY   
© Mizushima et al.; licensee BioMed Central Ltd. 2013