The Renascence of Neurotic Depression: Its Varied Dynamics and Implications for Outcome Research

Abstract

Kraepelin's observation of an emotion-connected subgroup of depressions led to the division of the common clinical depressions into endogenous and neurotic. But although the connotation of the former was clear, the latter had no positive diagnostic features, with the result that it fell very largely out of use. This paper presents evidence that there are depressions that are a consequence of neurotic anxiety. They can be positively diagnosed, and are resolved by overcoming the underlying neurotic anxieties. The neurotic basis of many cases of depression explains the success of different psychotherapeutic strategies in alleviating nonpsychotic depression, since 50% of neurotic cases respond to the nonspecific impact of the therapeutic interview. Unfortunately, the various outcome studies are muddied by failure to realize that a variety of psychopathologies are represented in nonpsychotic depression.