Melancholic and reactive depression: a reappraisal of old categories.
BACKGROUND
The dominant diagnostic model of the classification of depression today is unitarian; however, since Kurt Schneider (1920) introduced the concept of endogenous depression and reactive depression, the binary model has still often been used on a clinical basis. Notwithstanding this, to our knowledge, there have been no collective data on how psychiatrists differentiate these two conditions. We therefore conducted a survey to examine how psychiatrists in Japan differentiate patients with major depressive disorder who present mainly with melancholic features and those with reactive features.


METHODS
Three case scenarios of melancholic and reactive depression, and one-in-between were prepared. These cases were designed to present with at least 5 symptoms listed in the DSM-IV-TR with severity being mild. We have sent the questionnaires regarding treatment options and diagnosis for those three cases on a 7-point Likert scale (1 = "not appropriate", 4 = "cannot tell", and 7 = "appropriate"). Five hundred and two psychiatrists from over one hundred hospitals and community clinics throughout Japan have participated in this survey.


RESULTS
The melancholic case resulted significantly higher than the reactive case on either antidepressants (mean ± SD: 5.9 ± 1.2 vs. 3.6 ± 1.7, p < 0.001), hypnotics (mean ± SD: 5.5 ± 1.1 vs. 5.0 ± 1.3, p < 0.001), and electroconvulsive therapy (mean ± SD: 1.5 ± 0.9 vs. 1.2 ± 0.6, p < 0.001). On the other hand, the reactive case resulted in significantly higher scores compared to the melancholic case and the one- in-between cases in regards to psychotherapy (mean ± SD: 4.9 ± 1.4 vs. 4.3 ± 1.4 vs. 4.7 ± 1.5, p < 0.001, respectively). Scores for informing patients that they suffered from "depression" were significantly higher in the melancholic case, compared to the reactive case (mean ± SD: 4.7 ± 1.7 vs. 2.2 ± 1.4, p < 0.001).


CONCLUSIONS
Japanese psychiatrists distinguish between major depressive disorder with melancholic and reactive features, and thus choose different treatment strategies regarding pharmacological treatment and psychotherapy.
Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. jtmizushima@gmail.com.
Jin
J
Mizushima
Hitoshi
H
Sakurai
Yuya
Y
Mizuno
Masaki
M
Shinfuku
Hideaki
H
Tani
Kadunari
K
Yoshida
Chisa
C
Ozawa
Asako
A
Serizawa
Natsuko
N
Kodashiro
Shinya
S
Koide
Atsumi
A
Minamisawa
Eisaku
E
Mutsumoto
Nobuhiro
N
Nagai
Sachiko
S
Noda
Genichiro
G
Tachino
Tatsuichiro
T
Takahashi
Hiroyoshi
H
Takeuchi
Toshiaki
T
Kikuchi
Hiroyuki
H
Uchida
Koichiro
K
Watanabe
Hiroki
H
Kocha
Masaru
M
Mimura
D000275:Adjustment Disorders; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003866:Depressive Disorder / Q000175:diagnosis; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives