ANNA-MONIKA Prize 1999

As a well-established Tradition the ANNA-MONIKA Prize 1999 was awarded again in the framework of the biannual congress of the AGNP. The chairman of the international ANNA-MONIKA jury recalled the development of the ANNA-MONIKA FOUNDATION and gave reasons for the choice of the 1999 winners in his laudatio.

The ANNA-MONIKA FOUNDATION was established in 1965 by Consul Peter Rehme, a Businessman from Dortmund. In those years - driven by experiences in his family - he thought that besides flying to the moon it is necessary to support empirical research in the causes, the course and the treatment of depression in order to improve the quality of life of depressed human beings. At that time such a private initiative was very unusual in Germany and thus the ANNA-MONIKA Prize was among the first awards for relevant psychiatric research and developed favourably during the following 35 years to an internationally well-respected award in psychiatry.

For the 1999 award 15 applications with 38 papers from 8 countries had been submitted, most of them of high quality. By an intensive evaluation process the International ANNA-MONIKA Jury decided to award the ANNA-MONIKA Prize 1999 to Prof. Lewis L. Judd and Prof. Hagop S. Akiskal for their outstanding systematic investigations on subthreshold syndromes, particularly their prevalence, their relationship to major depressive disorders, their clinical consequences, and their theoretical relevance.

The three papers submitted by Prof. Judd and Prof. Akiskal are the result of the cooperation of the two main authors, a cooperation which started when they both worked at the National Institute of Mental Health (NIMH), Prof. Judd as the director of the NIMH and Prof. Akiskal as the Senior Science Advisor on affective disorders. During his investigations at the Memphis Mood Clinic Prof. Akiskal discovered the syndromal validity of minor chronic depressions on the basis of clinical, familial, polysomnographic and pharmacological accordances. Based on the data Prof. JUDD had ascertained in the framework of the NIMH Epidemiological Catchment Area (ECA) Program, he found out that each time in arbitrary months subthreshold depressive symptoms were twice as frequent as major depressive episodes.

On account of the data of 10.526 patients it is demonstrated in one paper that the expression of depressive symptoms often varies between subsyndromal and syndromal intensities. From these findings it is concluded that subthreshold, “minor”, intermittent, dysthymic or “major” depressions are no independent conditions of illness, but rather a clinically relevant continuum within the unipolar depression.

These findings have been confirmed in another paper by the observation of neurophysiologic sleep anomalies in residual, short-term depressive and dysthymic forms of depression. The described data could not be differentiated from the respective findings in patients with major depressive disorder. The authors interprete the subthreshold depressive syndrome in the sense of a biological inherent disposition to depressive illness.

The third paper outlines that in the course of a 12 years' catamnestic follow-up 431 patients with MDD had longer periods with “minor disorders” and subthreshold depressive disorders (42 percent) than MDD episodes (15 percent). The investigation proves that short-term and subsyndromal as well as intermittent depressive phenomena represent the modal manifestation of the unipolar depression.

With good reason the authors postulate a continuum of fluctuating symptoms between subthreshold depressions and major depressive disorders. The subthreshold depressive manifestations cannot be considered as good-natured because they are the reason for the most part of impairment of every-day competence and capability in the so-called free intervals. The previously valid opinion that a reduction of 50 percent of the values on the Hamilton Depression Rating Scale may be taken as an indication for a remission of the MDE has to be corrected.

The papers submitted are exemplary for the cooperation of researchers which has resulted in a clinically significant supplement to the theory of unipolar depressions. The investigation in over 10.000 persons as well as a 12 years longterm follow-up of 431 patients have to be considered as an outstanding example for effective organisation of research. The consideration of the findings of Judd and Akiskal facilitates a far more effective treatment of unipolar depressive episodes also in the up to now so-called free interval. The inclusion of multiple psychopathologic and biologic parameters necessitated a comprehensive investigative approach. The findings resulting from this obviously have evidential value and open a promising and encouraging perspective in the treatment of depressive disorders.

And, may I add, these findings are relevant in the contemporary context of managed care and financial restrictions insofar as there exists the danger that subthreshold psychiatric morbidity will be excluded from medical care. To counteract this danger the important findings of the winners of the ANNA-MONIKA Prize 1999 will help us. At the award ceremony the prize-winners gave their lecture on “Delineating the Longitudinal Structure of Depressive Illness: Beyond Clinical Subtypes and Duration Thresholds” in two parts: the first part was given by Hagop S. Akiskal, Professor of Psychiatry, Director of the International Mood Disorders Clinic, Department of Psychiatry, University of California, San Diego, and the second part by Lewis L. Judd, Professor of Psychiatry and Mary Gilman Marston Professor, Chairman of the Department of Psychiatry, University of California, San Diego. The paper is published in the following.

Before closing the ceremony the present chairman of the Inter-national Jury of the ANNA-MONIKA FOUNDATION announced his resignation and the election of the new chairman Prof. Dr. Dr. Fritz Henn.

Lewis L. Judd

Hagop S. Akiskal