Depressive neurosis is a concept coined by William Cullen to describe some patients.
Do you know what depressive neurosis is? It is a type of depression, which originally had to do with alterations in the nervous system, but which little by little has evolved to become what we know today as dysthymia.
Although it is a term currently in disuse, at the time it had a lot of repercussion, in addition to coming from psychoanalysis, a very recognized orientation in earlier times. In this article we will know what depressive neurosis is, what symptoms it causes and what are the most frequently used treatments to treat it.
What is neurosis?
Before explaining what depressive neurosis consists of, let’s define what neurosis is. Neurosis is a concept that was originally introduced by the Scottish physician William Cullen, in the year 1769.
Cullen used this term to refer to all those sensory and motor disorders that were caused by certain diseases of the nervous system.
However, later, and in the field of clinical psychology, the term “neurosis” was used to designate those mental disorders that distort the rational thinking of the individual, and that interfere with the functioning of all areas of his life.
However, it is also true that a person can be neurotic (which has to do with obsessive thoughts, a negative state, feelings of guilt, “paranoia” …) without the need to consider this neurosis a mental disorder. It all depends on the level of severity of the symptoms and their interference in daily life.
The typical symptoms and signs of neurosis are:
- Lack of interest in doing pleasant things
- Constant emotional distress
- Excessive worries
- Continued sadness
- Attacks of rage or anger at others
- Alterations in interpersonal relationships
- Intolerance towards others
- Feelings of anguish and guilt
- Inability to decide properly
- Excessive shyness
- Rituals or repetitive behaviors
At a psychophysiological level, the symptoms that appear are:
- Excessive sweating (especially in the hands)
- Sleep disturbances or problems
- Headaches or migraines
Depressive neurosis: what is it?
Depressive neurosis (also called neurotic depression) is a term that was previously used in psychiatry to designate those depressions whose origin was explained by an intrapsychic conflict. The origin of the description of this picture is psychoanalytic.
On the other hand, the term “neurotic depression”, specifically, was introduced by Sándor Radó, and was later replaced by dysthymia (currently dysthymic disorder). So, currently the term neurotic depression is no longer used, but dysthymia (they would be equivalent).
Dysthymia, on the other hand, no longer refers to psychodynamic or psychoanalytic concepts, and is defined (according to the DSM-5, Diagnostic and Statistical Manual of Mental Disorders) as a chronically depressed mood most of the day of the majority of days, of a minimum duration of 2 years (1 year in the case of children).
Depressive neurosis, which we can say is a subtype of depression or a subtype of neurosis (depending on the author), is characterized by the following symptoms: sad mood most of the time, low self-confidence, low self-esteem , excessive self-criticism and physical alterations.
The typical symptoms of depressive neurosis, beyond those already listed, are:
1. Depressed mood
It consists of the main symptom of depressive neurosis, as well as that of depression.
2. Loss of energy
There is a loss or decrease of energy.
3. Slowed cognitive processes
Speech and thinking are mainly slowed down. In addition, there is an added difficulty to concentrate.
Apathy is a general state of disinterest, coupled with a lack of motivation to do things. Furthermore, in patients with depressive neurosis, there is also a decrease in productivity in all senses.
Apathy is the lack of will, or energy, when doing things or moving. Thus, the individual with depressive neurosis does not usually feel like doing “nothing”, it is very difficult for them to start or do something, such as getting up in the morning, avoiding social activities, etc.
Feelings of despair also frequently appear .
7. Low self-esteem
Self-esteem is usually low, as in other types of depression or neurosis.
8. High self-criticism
The patient also frequently expresses self-critical thoughts (or messages) towards himself.
9. Feeling of anger
A feeling of anger appears that can make the patient “explode” in certain situations.
10. Difficulties deciding
The patient is unable to decide for himself, and this can occur even with “easy” or day-to-day (everyday) decisions.
11. Lack or excess appetite
Hunger is also altered, and an excess of appetite or a deficit of it may appear.
12. Feelings of guilt
Guilt feelings are another very characteristic symptom of depressive neurosis (which also appears frequently in depression).
13. Sleep disturbances
Finally, sleep alterations or disorders also appear, such as insomnia or the inability to rest well (non-restorative sleep).
Depressive neurosis has a multifactorial origin. Psychoanalysis is one of the orientations in psychology that has tried to answer what are the causes of depressive neurosis (in addition to being the orientation from which the term was born).
According to this orientation, the origin of depressive neurosis would be related to unpleasant experiences lived outside, with certain traumatic circumstances and with stressors. The external factors that could be causing said neurosis would be of great importance to the individual.
Regarding the mentioned stressors, we find two groups within them:
1. Individual performance
They would be the factors that have to do with the individual’s own performance ; If he makes different “mistakes” or “failures” in different facets of his life, he can develop an excessively critical feeling of himself (and even his own life).
2. Acts of emotional deprivation
According to psychoanalysis, and as the second group of stressors that could be at the origin of depressive neurosis, we find the so-called “events of emotional deprivation”.
An example of this type of event would be being separated from our loved ones by chance, and not having the necessary resources (on an emotional level) to face the situation in a healthy way.
The treatments that are usually used in depressive neurosis are:
1. Psychological treatment
When it comes to treating depressive neurosis (remember, current dysthymic disorder) there are different options in the context of psychological therapy. Cognitive behavioral therapy (CBT) is currently the most effective treatment in this regard (also to treat other types of depression).
Some of the tools or techniques most used in the context of CBT are:
- Cognitive techniques (for example cognitive restructuring)
- Scheduling enjoyable activities
- Environmental modification techniques (for example, stimulus control)
- Social Skills Training (EHS)
On the other hand, some studies, such as that of Besteiro and García (2000), suggest that hypnosis could also be considered one of the most effective treatments for depressive neurosis, along with relaxation (second).
The objective of psychological therapy in these cases, and in a generic way, will be to improve the patient’s mood and work with their most internal conflicts.
2. Pharmacological treatment
Regarding the pharmacological treatment of depressive neurosis, it should be mentioned that there is no drug that “cures” this disorder (as practically no mental disorder), and that the most ideal thing will always be to go to a multidisciplinary treatment that also includes psychological therapy.
However, antidepressant drugs are used above all, especially SSRIs (Selective Serotonin Reuptake Inhibitors), which are the first-line pharmacological treatment. Examples of SSRI drugs are: fluoxetine, sertraline, paroxetine, and fluvoxamine.
- American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
- Besteiro-González, JL and García-Cueto, E. (2000). Use of hypnosis in the treatment of major depression. Psicothema, 12 (4): 557-560.
- Laplanche, J. & Pontalis, JB (1996). Dictionary of psychoanalysis (Fernando Gimeno Cervantes, trad.) [Vocabulaire de la Psychanalyse]. Under the direction of Daniel Lagache. Buenos Aires: Paidós.
- Pérez, M., Fernández, JR, Fernández, C. and Amigo, I. (2010). Guide to effective psychological treatments I and II :. Madrid: Pyramid.
- Vallejo J. & Menchón, JM. (1999). Dysthymia and other non-melancholic depressions. In: Vallejo J, Gastó C. Affective disorders: anxiety and depression (2nd ed). Barcelona: Masson.