Over time, the concept of psychotic depression has become separated from that of endogenous depression. Psychotic depression has retained a secure place in the official
schemes, as a variant of severe depression. It is clearly definable, by presence of delusions (particularly if mood-congruent) Inhibitors,research,lifescience,medical or hallucinations and there is validating evidence, for instance in the better selleck chemicals llc response of such depressions to electroconvulsive therapy (ECT) or antipsychotic drugs, than to antidepressants alone. Endogenous depression and its opposite arc more problematic, both regarding classificatory status and terminology. There is evidence in support. The factor-analytic and cluster- analytic studies of the 1960s and 1970s in most cases found a dimension or group.26 On detailed examination, Inhibitors,research,lifescience,medical this sometimes looks more like the psychotic element and sometimes the melancholic. However, neurotic depression did not emerge as clearly as a single group in these studies, and is heterogeneous.26 Dexamethasone Inhibitors,research,lifescience,medical nonsuppression occurs predominantly in the endogenous group, and to some extent, so do other neuroendocrine abnormalities, such as blunting of growth hormone response to clonidinc and prolactin response to tryptophan. Regarding
treatment, the best ECT response is associated with the presence of psychomotor retardation and depressive delusions, characteristic of psychotic depression.27 Inhibitors,research,lifescience,medical The endogenous picture may be useful as a characteristic of depressions that respond better to antidepressants than placebo, but this is not clear. However, boundaries are weak, with mixed cases common, Inhibitors,research,lifescience,medical and distributions on factors do not show consistent and convincing bimodality which would indicate separation of disorders. The relationship to severity, the loose and confusing definitions, and the overlap between psychotic depression and melancholia bedevil the
area. Terminology has remained unsatisfactory. The term neurotic has dropped out of use, particularly in American psychiatry, where it was abandoned because of its diversity of meaning,28 partly because of previous associations not with psychoanalysis, and partly to avoid the emphasis placed earlier in the US on personality and charactero logical aspects. Dysthymia, a chronic disorder that would earlier have been regarded as one form of neurotic depression, is now viewed as a mood disorder. In a somewhat parallel way, the term cyclothymic personality has been replaced by cyclothymic disorder, a form of bipolar mood disorder. The term endogenous was abandoned in official schemes because it is really a symptom syndrome that we refer to these days.