The spectra of neurasthenia and depression: course, stability and transitions.
BACKGROUND
Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood.


METHODS
In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account.


RESULTS
The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low.


CONCLUSIONS
Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.
Gamma
Alex
A
Zurich University Psychiatric Hospital, Research Department, Lenggstr. 31, 8032 Zurich, Switzerland. gamma@bli.unizh.ch
Angst
Jules
J
Ajdacic
Vladeta
V
Eich
Dominique
D
Rössler
Wulf
W
D000328:Adult; D017668:Age of Onset; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009440:Neurasthenia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013557:Switzerland