of “neurotic depression” was removed from the official DSM-III lexicon in 1980,
replaced with the heftier sounding “generalized anxiety disorder” (GAD) and
dysthymia. Consequently, clinicians
frequently see patients with the “comorbidity” of GAD and dysthymia, which
likely represents the same class of patients that used to be labeled “neurotic
depression” pre-1980. However, this phrase more clearly captures the symptoms experienced by these patients,
without pseudo-scientific jargon. What is central to this syndrome is chronic
moderate anxiety and depressive symptoms that do not meet criteria for a major depressive
episode most of the time. These
patients do not have recurrent discrete major depressive episodes separated by
periods of relatively normal functioning, and their anxiety symptoms are
equally disabling as their mood symptoms.
When treating neurotic depression (GAD/dysthymia), clinicians often use the same approach as in treatment of recurrent unipolar depression, i.e. long-term antidepressant treatment. This is partly because DSM-IV labels all these syndromes “major depressive disorder” (and as said, adding comorbidities for some patients with dysthymia and GAD). Nevertheless, the conflation of these conditions diagnostically leads to unproven and possibly unnecessary treatments (anti-Hippocratic).
Long-term benefits with antidepressants are far from established in GAD and dysthymia while short-term efficacy makes little sense in these chronic conditions especially because these persons tend to have chronic depressive symptoms in the setting of notable psychosocial stressors. Lack of attention to those psychosocial stressors, either through psychotherapies or other means, will often lead to poor antidepressant response. The psychosocial interventions in these circumstances are primary,the use of antidepressants secondary (and sometimes not necessary). The role of psychosocial stressors in neurotic depression should be distinguished from recurrent unipolar depressive disorder, however. Neurotic depression is a clinical presentation, not a disease, in which psychosocial problems are the primary force.