Symptomatology of Therapy-Resistant Depressions

Summary

1. This paper has reported about symptomatology of chronic depressions on the basis of 673 unselected patients with endogenous and reactive depressions (ICD: 296.0, 296.2, 298.0, 300.4). The analysis uses the psychopathological and somatic symptoms as well as some anamnestic data, which are routinely documented with the AMP-system on admission to the psychiatric hospital.

2. With the retrospective data a genuine therapy resistance cannot be established precisely. Therefore chronicity has been used as an indirect criterion of therapy resistance. In our analysis a depression has been described as “chronic”, if its immediate manifestation had begun more than six months before admission or if it showed a chronic, progredient course and an incomplete or no remission following previous manifestations. The groups defined in this way have been compared with their complementary groups in regard to symptomatology.

3. The chronic group defined by the immediate duration has been characterised by a greater frequency, especially of dysthymic symptoms, but usually lesser intensity of symptoms. The other chronic group defined by course and degree of remission also showed less intensity, but also a lesser frequency of symptoms. Only the symptoms of hostile and tense affect as well as suicidal thoughts and acts were more frequent here. These findings confirm in general the clinical observations as reported by earlier investigators.

4. The high frequency of reactive depressions in the “chronic” group indicates that structure of personality and circumstances of life are important for the symptomatology of chronic or pharmacotherapy resistant depressions respectively.

5. Finally a few possible consequences of the findings for the pharmacotherapy of at least some chronic depressions have been discussed:

a) the depression remains untreated for too long a time because of the mild intensity of the symptoms;

b) the drug treatment has too low a dosage because of the mild intensity of the symptoms;

c) the emphasis in the drug treatment is sedative rather than antidepressive because of the special kind of symptoms;

d) the drug treatment loses its indication in the course;

e) the light time for discontinuing the drug treatment was missed;

f) the drug treatment is not indicated at all.