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The phenomenology of depression

Published online by Cambridge University Press:  28 April 2020

N.C. Andreasen*
Affiliation:
Department of Psychiatry, The University of Iowa College of Medicine, 500 Newton Road, Iowa City, Iowa52242
W.M. Grove
Affiliation:
University of Minnessota, Minneapolis
J. Endicott
Affiliation:
New York State Psychiatric Institute, New York City
W.H. Coryell
Affiliation:
Department of Psychiatry, The University of Iowa College of Medicine, 500 Newton Road, Iowa City, Iowa52242
W.A. Scheftner
Affiliation:
Rush Presbyterian-St. Luke's Medical Center, Chicago
R.M.A. Hirschfeld
Affiliation:
Clinical Research Branch, NIMH, Washington, D.C.
M.B. Keller
Affiliation:
Massachussetts General Hospital, Boston, USA
*
*Correspondence and reprints.
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Summary

While some investigators believe that the concept of depression is a continuum with mild and severe forms reflecting essentially the same entity, most suspect that the concept is instead heterogeneous and consists of a group of discrete subtypes. If this is so, identifying subtypes is a major priority. Ultimately such subtypes must be understood in terms of their underlying neural and even molecular mechanisms. Yet in order to search for such mechanisms, we still must begin with clinical phenomenology.

Two major subtypes of serious depressions have been proposed. Endogenous or melancholic depression is one, while bipolar depression is another. Thinking about both these subtypes tends to assume an underlying biogenic mechanism that is relatively autonomous, although not necessarily free of environmental influences.

This paper examines a series of attempts to identify discrete subtypes of depression. One approach, used in a series of investigations, involves the use of mathematical techniques such as cluster analysis in order to identify phenomenologically similar subgroups within the depressive spectrum. This approach has consistently identified a melancholic or endogenous syndrome. Our attempts to validate the concept of endogenous depression through examining external correlates, such as family history, have been less successful.

An alternate method for subtyping depression stresses that the bipolar subtype represents a discrete form of severe endogenously caused depression. We bave examined the phenomenology of bipolar versus unipolar depression and found it to differ significantly in a number of respects. Thus, endogenous depression and bipolar depression may represent different phenontena.

Résumé

Résumé

Tandis que certains chercheurs définissent la dépression comme continuum composé d'états bénins et graves reflétant essentiellement la même identité, la plupart des chercheurs pensent que le concept de la dépression est, en revanche, héterogène et constitué par un groupe de sous-catégories distinctes.

Si ceci est le cas, identifier ces sous-catégories devient une priorité majeure. De telles sous-catégories doivent être comprises par rapport à leurs mécanismes fondamentaux neuraux, voire même moléculaires. Pourtant, afin d’effectuer des recherches à ce sujet, il faut toujours commencer par la phénoménologie clinique.

Dans les dépressions graves, deux sous-catégories majeures ont été proposées; l'une est la dépression endogène ou mélancolique et l'autre la dépression bipolaire. On a tendance à postuler l'existence d'un mécanisme biogénique fondamental qui est relativement autonome, mais pas forcément libre d'influences externes/environnementales.

Cet article étudie une série de tentatives visant à l'identification des sous-categories distinctes de la dépression. Une approche, utilisée dans une série d'investigations, consiste à utiliser des techniques mathématiques telles que l'analyse par clusters, afin d'identifier d'une façon phénoménologique des sous-catégories similaires dans le spectre de la dépression.

Cette approche a identifié d'une façon suivie un syndrome mélancolique ou endogène. Nos efforts pour valider le concept de la dépression endogène, par exemple la recherche d'antécédents familiaux, ont eu moins de succès.

Une méthode alternative de sous-catégoriser la dépression souligne que la sous-catégorie bipolaire représente une forme distincte d'une dépression grave provoquée d'une façon endogène. Nous avons examiné la phénoménologie de la dépression bipolaire versus la dépression unipolaire et nous avons trouvé qu'il y a un certain nombre de caractéristiques qui différencient significativement la première de la dernière. Il est donc fort possible que la dépression endogène et la dépression bipolaire soient deux phénomènes distincts.

Type
Review
Copyright
Copyright © European Psychiatric Association 1988

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Footnotes

From the National Institute of Mental Health (Clinical Research Branch Collaborative Program on the Psychology of Depression - Clinical Studies) conducted with the participation of the following investigators : G.L. Klerman, M.D. (Chairperson, Boston) ; R.M.A. Hirschfeld, M.D. (Project Director and Co-Chairperson, Washington D.C.) and P. Griffith, Ph.D. (Washington D.C.) ; M.B. Keller, M.D. and P. Lavori, Ph.D. (Boston) ; J.A. Fawcett, M.D. and W.A. Scheftner, M.D. (Chicago) ; N.C. Andreasen, M.D., W. Coryell, M.D., G. Winokur, M.D. and P. Wasek, B.A. (Iowa City) ; J. Endicott, Ph.D., P. McDonald-Scott, M.A. and J.E. Loth, M.S.W. (New York) ; J. Rice, Ph. D., T. Reich, M.D. and D. Altis, B.A. (St. Louis). Other contributors include : P. J. Clayton, M.D., M.M. Katz, Ph. D., E. Robins, M.D., R.W. Shapiro, M.D. and R. Spitzer, M.D. This paper was reviewed and endorsed by the Publications Committee of the Collaborative Depression Study.

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