You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
There is growing evidence of substantial clinical heterogeneity in neurotic depression. In a prospective follow-up study, the author and co-workers found recurrent major depression or bipolar disorder in 40% of cases that had been diagnosed neurotic depression. Others suffered from chronic dysthymia or subclinical mood disorders. These patients present with neurotic, narcissistic, or existential concerns. Clinicians who are disinclined to use medication tend to focus on the psychological aspects of the condition; but failure to recognize and treat the core affective pathology leads to a therapeutic impasse in many cases. The patient who does not recover may then be misdiagnosed as borderline. Some physicians rely excessively on tricyclic antidepressants, and tend to label patients who do not respond to this one pharmacological modality as treatment-resistant or characterological depressives. Cases of chronic depression fell into the categories of residual major depression, anxious or atypical depression, and dysthymic disorder. The latter includes cases of subaffective dysthymia and character-spectrum depressive disorder. The author offers suggestions for diagnosing and treating these ostensibly hopeless conditions. There is a comprehensive, sophisticated bibliography.