| disease | Depressive Neurosis |
| alias | Depressive Neurosis, Dysthymic Disorder |
Depressive neurosis, also known as dysthymic disorder, refers to a type of neurosis characterized by persistent low mood, often accompanied by anxiety, physical discomfort, and sleep disturbances. Patients seek treatment but do not exhibit significant motor inhibition or psychotic symptoms, and their daily lives are not severely affected. According to a nationwide epidemiological survey on neurosis in 12 regions, the prevalence of this condition was found to be 3.1%. Reports from the psychiatry department of West China Medical University indicate that depressive neurosis patients accounted for 21.2% of psychiatric outpatient cases and 70.6% of neurosis cases. A survey conducted at a county hospital outpatient department reported that it accounted for 27.8% of neurosis cases, suggesting a relatively high prevalence. It is more common in women.
bubble_chart Etiology
1. Psychosocial Factors This disorder is often induced by psychosocial factors, such as marital conflicts, divorce, separation from loved ones, unexpected disabilities, work difficulties, interpersonal tensions, as well as severe physical illnesses. These factors cause patients to worry, become anxious, and subsequently develop depression, distress, and despondency. In normal individuals, such suppressed emotions typically dissipate quickly after疏导. However, in patients with depressive neurosis, the depressive state persists for a longer duration, especially in those with depressive personality disorders. Consequently, the course of depressive neurosis tends to be slow and protracted. Individuals with personality disorders often exhibit characteristics such as low mood, reticence, a tendency to ruminate, lack of energy, a pessimistic outlook on everything, self-reproach over past events, lack of confidence in the future, and a sense of overwhelming difficulties in facing reality. These individuals clearly lack self-confidence and may experience feelings of inferiority.
2. Biochemical Changes In depressive neurosis, there is little evidence of biochemical changes, such as decreased levels of norepinephrine or serotonin in the brain. However, since depressive neurosis can still be alleviated by antidepressant treatment, the mechanism by which antidepressants work in these patients remains to be explored.bubble_chart Clinical Manifestations
The depressive symptoms of this condition are relatively mild and rarely progress to a severe degree, but patients describe them vividly and concretely. For instance, patients often complain of low mood, feeling downcast or dejected, and perceiving their surroundings as if wearing dark sunglasses—everything appears dim and gloomy. They lose interest and enthusiasm for work, lack confidence, feel pessimistic and hopeless about the future, and frequently experience mental fatigue and exhaustion. Some patients may have suicidal thoughts. This depressive mood fluctuates over time, varying with circumstances and daily life, but it persists most of the time. Despite this, their work, studies, and daily life show no significant abnormalities, so they often maintain good contact with their environment, and others may not recognize it as depression.
Alongside depressive symptoms, patients may also experience physical symptoms such as chronic pain like headaches, backaches, or limb pain, often without identifiable causes. Additionally, there may be autonomic nervous system dysfunctions, such as stomach discomfort, diarrhea or constipation, and insomnia. According to statistics from the Psychiatry Department of West China Medical University, about 30% of patients experience varying degrees of anxiety, while 12% report irritability and restlessness. Over one-third of patients exhibit self-blame tendencies, and three-fourths feel life is meaningless and are pessimistic about the future, with a few having entertained suicidal thoughts. Some patients may have hypochondriacal concerns. However, there are no prominent biological symptoms such as early morning awakening, diurnal mood variation, or significant weight loss.
1. Meets the diagnostic criteria for neurosis.
2. Persistent grade I to grade II depression as the main clinical manifestation, accompanied by at least three of the following symptoms:
(1) Reduced interest, but not lost;
(2) Pessimism about the future, but not hopelessness;
(3) Self-perceived fatigue or low energy;
(4) Lowered self-evaluation but willing to accept encouragement and praise;
(5) Unwilling to initiate social interactions but responsive to passive contact, willing to accept sympathy and support.
(6) Thoughts of death, but with significant reservations;
(7) Self-perceived severe and difficult-to-treat condition, yet actively seeking treatment with hope for recovery.
3. Absence of any of the following symptoms:
(1) Significant psychomotor retardation;
(2) Early morning awakening and symptoms worsening in the morning and easing at night;
(3) Severe guilt or self-blame;
(4) Persistent loss of appetite and significant weight loss (not due to physical illness);
(5) More than one suicide attempt;
(6) Inability to care for oneself;
(7) Hallucinations or delusions;
(8) Severe lack of insight.
4. Duration of at least 2 years, with depressed mood present for most of the course. If there are normal intervals, each should not exceed two months.
Since depressive symptoms can appear in many diseases, differential diagnosis should be made with the following conditions.
1. **Affective disorder depressive episode** (also known as endogenous depression): Begins without obvious psychosocial factors, with severe symptoms, often including psychomotor retardation. Depressive symptoms may be accompanied by psychotic features such as delusions, hallucinations, and self-blame. Biological changes are also present, such as diurnal mood variation (worse in the morning, better at night), early morning insomnia, significant weight loss not due to physical causes, a history of severe suicide attempts or family history of suicide, previous bipolar episodes, or a history of three or more unipolar depressive episodes, making it easily distinguishable from depressive neurosis.
3. **Schizophrenia**: Often characterized by distinct thought disorders and common symptoms like hallucinations and delusions. Even if depressive symptoms are present, it is not difficult to differentiate from depressive neurosis.
4. **Anxiety disorder**: Often accompanied by depressive symptoms, making differentiation challenging—some even refer to it as anxiety-depression syndrome. However, identifying the primary symptom is crucial. Anxiety disorders are primarily characterized by anxiety symptoms. If there are acute anxiety attacks or results from anxiety and depression scales, differentiation from depressive neurosis becomes easier. {|123|}
bubble_chart Treatment Measures
The treatment principles are the same as for other neuroses, combining psychotherapy with medication.
1. Psychotherapy: Guide patients to articulate the disease-causing factors and their inner distress. Explain to patients that their condition is not a psychiatric disorder to alleviate their anxiety. At the same time, work with their relatives to collaborate with doctors in encouraging patients to develop a correct understanding and cope with the encountered psychosocial factors and crises.
2. Medication: Mainly involves antidepressants, with dosages that should not be excessive. Generally, tricyclic antidepressants such as amitriptyline and doxepin are used, with amitriptyline at 50–100 mg daily and doxepin at 50 mg before bedtime. Dosage should be tailored to the individual; if the dose is insufficient, it can be gradually increased. Sometimes, benzodiazepines such as diazepam at 5–15 mg daily or alprazolam at 0.4 mg three times daily may also be used. These medications have both anti-anxiety and antidepressant effects. For example, diazepam at 5 mg before bedtime or estazolam at 2 mg nightly often leads to improved sleep, which in turn facilitates emotional improvement.
Most patients have a prolonged course of illness. If their psychological factors are singular and they do not exhibit depressive personality traits, the prognosis is favorable. However, if the condition is recurrent, fluctuating with psychological influences, and accompanied by depressive personality disorder, the illness tends to be protracted with a poorer prognosis.
