Depressive neurosis: symptoms, causes and treatment

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 has gradually 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 the fact that it came from psychoanalysis, a very recognized orientation in earlier times. In this article we will know what is the depressive neurosis, what symptoms it causes and which are the most frequently used treatments to treat it.

What is neurosis?

Before explaining what depressive neurosis consists of, we are going to define what neurosis is. The neurosis is a concept that was originally introduced by the Scottish physician William Cullen in 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 interfere in the functioning of all areas of his life.

However, it is also true that a person can be neurotic (what has to do with obsessive thoughts, a negative state, feelings of guilt, "paranoias"...) without the need to consider this neurosis a mental disorder. It all depends on the level of severity of the symptoms and their interference with daily life..

Symptoms

Typical symptoms and signs of neurosis are:

• Lack of interest in doing pleasurable things
• Constant emotional suffering
• Excessive worries
• Continuous sadness
• Irritability
• Attacks of rage or anger at others
• Disturbances in interpersonal relationships
• Intolerance towards others
• Anxiety
• Feelings of anguish and guilt
• Inability to decide adequately
• Excessive shyness
• Abulia
• Anhedonia
• Rituals or repetitive behaviors

At the psycho-physiological level, the symptoms that appear are are:

• Excessive sweating (especially in the hands).
• Sleep disturbances or problems
• Headaches or migraines

Depressive neurosis: what is it?

The 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 psychoanalytical.

On the other hand, the term "neurotic depression", in particular, was introduced by Sándor Radóand was later replaced by dysthymia (now dysthymic disorder). Thus, nowadays the term neurotic depression is no longer used, but dysthymia (they would be equivalent).

Dysthymia, on the other hand, no longer alludes 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 for most of the day on most days of the year, of at least 2 years duration (at least 1 year).The duration of depressive neurosis is at least 2 years (1 year in the case of children).

Depressive neurosis, which can be said to be 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 disturbances.

Symptoms

Typical symptoms of depressive neurosis, beyond those already listed, are:

1. Depressed mood

It is 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

Mainly, speech and thinking are slowed down.. In addition, there is an added difficulty in concentrating.

4. Apathy

Apathy is a generalized state of disinterest, together with a lack of motivation to do things. In patients with depressive neurosis, in addition, there is also a decrease in productivity in all senses.

5. Abulia

Abulia is the lack of will, or energy, when it comes to doing things or moving around.. Thus, the individual with depressive neurosis usually does not feel like doing "nothing", has a hard time starting or doing anything, such as getting up in the morning, avoids social activities, etc.

6. Despair

The following also appear frequently feelings of despair.

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 manifests self-critical thoughts (or messages) towards himself/herself..

9. Feeling of rage

A feeling of rage appears that can make the patient "explode" in certain situations.

10. Difficulty in making decisions

The patient feels unable to decide for him/herself, and this may occur even in the face of "easy" or day-to-day decisions.This may occur even in the face of "easy" or day-to-day (everyday) decisions.

11. Lack or excess of appetite

Hunger is also altered, and an excess or deficit of appetite may appear.

12. Feelings of guilt

Feelings of guilt are another very characteristic symptom of depressive neurosis (which also appears frequently in depression). (which also appears frequently in depression).

13. Sleep disturbances

Finally, sleep disturbances or disorders also appear, such as insomnia or the impossibility of resting well (non-restorative sleep)..

Causes

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 (besides being the orientation from which the term was born).

According to this orientation, the origin of depressive neurosis would be related to unpleasant experiences from the outsidewith certain traumatic circumstances and stressors. The external factors that could be causing such neurosis would be of great importance to the individual.

Stressors

Regarding the stressors mentioned above, we find two groups within them:

1. Individual performance.

These would be the factors that have to do with the individual's own performanceIf the individual makes different "mistakes" or "failures" in different facets of his life, he may develop an overly critical feeling of himself (and even of his own life).

2. Facts of emotional deprivation

According to psychoanalysis, and as a second group of stressors that could be at the origin of depressive neurosis, we find the so-called "emotional deprivation events".

An example of this type of event would be to be separated from our loved ones by chance.and not having the necessary resources (on an emotional level) to deal with the situation in a healthy way.

Treatment

The treatments that are usually used in depressive neurosis are:

1. Psychological treatment

When treating depressive neurosis (remember, current dysthymic disorder) there are different options in the context of psychological therapy. Cognitive-behavioral therapy (CBT) is the most effective treatment at present in this regard (also for treating other forms of depressive neurosis). in this sense (also to treat other types of depression).

Some of the most commonly used tools or techniques in the context of CBT are:

• Cognitive techniques (e.g. cognitive restructuring).
• Programming of pleasant activities
• Environmental modification techniques (e.g. 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, together with relaxation (in second place).

The aim of psychological therapy in these cases, and in a generic way, will be to to improve the patient's state of mind and to work with his or her innermost conflicts..

Pharmacological treatment

As for the pharmacological treatment of depressive neurosis, it is worth mentioning that there is no drug that "cures" this disorder (like practically no mental disorder), and that the most suitable approach will always be to go to a multidisciplinary treatment that also includes psychological therapy..

However, Antidepressant drugs are mainly used, especially SSRIs (Selective Serotonin Reuptake Inhibitors), which are the pharmacological treatment of first choice. Examples of SSRI drugs are: fluoxetine, sertraline, paroxetine and fluvoxamine.

Bibliographic references:

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
• Besteiro-González, J.L. and García-Cueto, E. (2000). Use of hypnosis in the treatment of major depression. Psicothema, 12(4): 557-560.
• Laplanche, J. & Pontalis, J.B. (1996). Dictionary of psychoanalysis (Fernando Gimeno Cervantes, trans.) [Vocabulaire de la Psychanalyse]. Under the direction of Daniel Lagache. Buenos Aires: Paidós.
• Pérez, M., Fernández, J.R, Fernández, C. and Amigo, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pirámide.
• 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.