The depressive neurosis is a psychopathological disorder characterized by the presence of a state of constantly sad mood. In this way, it can be considered as a mild and permanent case of depression.
People who have this disorder have a low mood for long periods of time. Likewise, they experience a high physical inactivity and a generalized lethargy.
In addition, depressive neurosis is usually accompanied by somatic alterations and sleep disorders. The subjects with this disorder can preserve a minimum degree of functioning, however, the low state of mind causes them a high discomfort and a disastrous quality of life.
At present, the diagnosis of depressive neurosis does not exist as such. In fact, it has been replaced in diagnostic manuals by the disorder known as dysthymia.
However, depressive neurosis served to lay the foundations of mood disorders and incorporate valuable information about depressive psychopathologies.
In the present article the characteristics of the depressive neurosis are reviewed. Its symptoms, its diagnosis and its causes are explained and the interventions that can be carried out to intervene are reviewed.
Characteristics of the depressive neurosis
Depressive neurosis is a mood disorder that is defined by seven stable and major characteristics. These are:
- It results in a primary alteration of mood.
- It presents a stable and prolonged psychopathology.
- It has a cerebral representation.
- It has a periodic nature.
- It is associated with a probable genetic vulnerability.
- It is related to specific personality traits of the individual.
- It allows an integral biopsychosocial restitution.
Thus, the depressive neurosis constitutes a certain type of depression. This depressive subtype is defined by the presentation of a less intense symptomatology and a chronic or fluctuating evolution of life.
In fact, for its diagnosis, the depressive neurosis has the following criteria that define the patient’s condition:
“Depressive mood most of the day, most days for a period of not less than two years without being more than two months free of symptoms and without major mood disorder or mania.”
Depressive neurosis, then, differs from major depression by two fundamental aspects.
First, depressive symptoms are milder and do not reach the typical intensity of major depression. Secondly, the evolution and prognosis of the depressive neurosis is more chronic and stable than that of depression.
Depressive neurosis is characterized by the triad of typical symptoms: decreased vitality, depressed mood and slowed thinking and speech.
These three manifestations are the most important of the disorder and occur in all cases. However, the symptomatology of depressive neurosis is much more extensive.
Thus, in this disorder different emotional, cognitive and behavioral symptoms may appear. The most prevalent are:
- Loss of interest in daily activities.
- Feelings of sadness.
- Lack of energy.
- Fatigue or lack of energy
- Low self-esteem.
- Difficulty concentrating.
- Difficulty in making decisions.
- Excessive anger
- Decrease in productivity
- Avoidance of social activities.
- Feelings of guilt.
- Lack or excess of appetite.
- Problems sleeping and sleep disorder.
Depressive neurosis in children may be slightly different. In these cases, apart from the aforementioned manifestations, other symptoms are usually present, such as:
- Generalized irritability throughout the day.
- Low school performance and isolation.
- Pessimistic attitude
- Lack of social skills and little relational activity.
Depressive neurosis causes an abnormally low mood and a generalized feeling of weakness. These typical symptoms of psychopathology are often accompanied by other somatic manifestations.
The most common are dizziness, palpitations, fluctuations in blood pressure, loss of appetite and functional disorders of the gastrointestinal tract.
With the passage of time, the mood gets worse and the feelings of sadness become more noticeable in the subject’s life. This develops a remarkable apathy and presents difficulties to experience gratifying sensations and positive emotions.
In several cases, depressive neurosis may present with other symptoms such as reduced motor activity, poor facial expression, slow thinking and abnormally slow speech.
Usually, these symptoms affect the person’s daily life. However, it is common for subjects with depressive neurosis to continue to “pull”. They can keep their job even if it costs them a lot to concentrate and perform properly, to have a stable relational life and an optimal family context.
However, the performance of these activities never provide gratification in the subject. He performs activities for duty or obligation, but never for the desire to carry them out.
On the other hand, most cases of depressive neurosis present with sleep disorders. The difficulty to fall asleep and the awakenings during the night are the most common. These alterations may be accompanied by palpitations or other signs of anxiety.
Causes of depressive neurosis according to psychoanalysis
According to the psychoanalytic currents, which were those who coined the depressive neurosis disorder, this psychopathology is caused by the psychogenic condition of the individual.
In this sense, the appearance of depressive neurosis is related to traumatic circumstances or external unpleasant experiences.
Psychoanalytic theories postulate that, as a rule, the external factors that can cause depressive neurosis are particularly important for the subject.
In reference to stress situations that lead to depressive neurosis, two main groups are postulated.
The first one is related to the performance of the person. Numerous failures produced in different areas of the subject’s life lead to an interpretation of “autofallo” or “vida failed”.
The second group, on the other hand, is formed by the so-called facts of emotional deprivation. In this case, when the individual is forced to separate from his loved ones and does not have the ability to cope with the situation, he can develop a depressive neurosis.
Current research on the disorder has put aside psychoanalytic theories and has focused on the study of other types of factors.
In this sense, at present no element has been detected as the cause of the pathology. However, certain factors that could be related have been connoted.
In general, these can be biological factors, genetic factors and environmental factors.
The psychopathology referring to the depressive neurosis is very heterogeneous, a fact that makes its investigation difficult. However, certain studies show that the disorder could be explained through neurophysiological, hormonal and biochemical aspects.
The neurophysiological findings in depressive neuroses have been one of the most important aspects of their diagnosis.
One of the most studied elements is related to REM latency. Thus, people with depressive neurosis seem to have a significantly lower REM sleep latency than the rest of the population.
b) Hormonal studies
Within the neuroendocrine tests, the dexamethasone suppression test has been one of the most studied in the depressive neurosis.
In general, the results obtained show that subjects with depressive neurosis have a relatively lower percentage of “non-suppressors” than people with major depression.
Finally, as regards biochemistry, several studies show that depressive neurosis could be related to serotonin receptors.
In this sense, it is postulated that individuals with depressive neurosis could have a lower number of receptors of this substance. However, these findings have been corroborated by some studies and rejected by others.
Alterations in mood appear to have important genetic components in their etiology. In this sense, people who have a history of depression in their family may be more susceptible to developing depressive neurosis.
Finally, this last group of factors have to do with life situations that are complex to face for people.
They are remarkably related to the concepts postulated by psychoanalysis and could play an important role in the development of pathology.
At present, the diagnosis of depressive neurosis has been evicted. This means that the term neurosis is no longer used for the detection of this alteration of mood, however, it does not mean that the disorder does not exist.
Rather, depressive neurosis has been reformulated and renamed for persistent depressive disorder or dysthymia. The similarities between both pathologies are many, so they can be considered equivalent disorders.
In other words, the subjects who years ago were diagnosed with depressive neurosis are currently diagnosed with dysthymia.
The symptoms and symptoms are practically identical, and refer to the same psychological disorder. The criteria established for the diagnosis of persistent depressive disorder (dysthymia) are:
- Depressed mood during most of the day, present more days than those who are absent, as shown by subjective information or observation by other people, for a minimum of two years.
- Presence, during depression, of two (or more) of the following symptoms:
- Little appetite or overfeeding.
- Insomnia or hypersomnia.
- Little energy or fatigue.
- Low self – esteem.
- Lack of concentration or difficulty in making decisions.
- Feelings of hopelessness
- During the two year period (one year in children and adolescents) of the alteration, the individual has never been without the symptoms of Criteria 1 and 2 for more than two months in a row.
- The criteria for a major depression disorder can be continuously present for two years.
- There has never been a manic episode or a hypomanic episode, and the criteria for cyclothymic disorder have never been met .
- The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified disorder of the spectrum of schizophrenia and other psychotic disorder.
- The symptoms can not be attributed to the physiological effects of a substance (eg, a drug, a medication) or to another medical condition (eg, hypothyroidism).
- Symptoms cause clinically significant discomfort or deterioration in social, occupational or other important areas of functioning.
The current treatment of depressive neurosis is complex and controversial. The subjects with this alteration usually require medication, although it is not always satisfactory.
In this sense, the intervention of this psychopathology usually includes both psychotherapy and pharmacological treatment.
The pharmacological treatment of depressive neurosis is subject to some controversy. Thus, at present there is no drug that is capable of completely reversing the alteration.
However, selective serotonin reuptake inhibitors (SSRIs) are the most effective antidepressants and, therefore, the pharmacological treatment of first choice.
Among them, the most commonly used drugs are fluoxetine, paroxetine, sertraline and flovoxamine.
However, the action of these drugs is slow, and the effects do not usually appear until 6-8 weeks of treatment. In turn, the efficacy of antidepressant drugs is also limited in the treatment of depressive neurosis.
Several studies show that the efficacy of these drugs would be less than 60%, while the placebo would reach 30% efficacy.
The psychotherapy takes on particular importance in the treatment of depressive neurosis due to the low efficiency presenting faramacoterapia.
More than half of subjects with this disorder do not respond well to medications, so psychological treatments are key in these cases.
Currently, cognitive behavioral therapy is the psychotherapeutic tool that has been shown to be most effective in the treatment of mood disorders.
The most commonly used cognitive-behavioral techniques in depressive neurosis are:
- Modification of the environment.
- Increase in activity
- Training in skills.
- Cognitive restructuring.