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Depression can be understood as an affect, a mood, a symptom or a disorder. For depression as a mental disorder, considerable progress has recently been made with respect to classification, etiology, pathogenesis and treatment (Paykel, 1982; Malt, 1983). Several types of depression have been delineated according to family patterns, symptomatology, premorbid personality, releasing factors and effect of various treatments. Reviews of this development from a psychoanalytic viewpoint have been presented by Mendelson (1974) and Alnæs (1983).
Depressions can be classified from mild to severe according to the degree of functional impairment. Depressive neuroses (dysthymic disorder) with a mild degree of functional impairment have long been considered a clear indication for psychoanalysis. Recently, short-term psychotherapies based on cognitive (Beck et al., 1985) or interpersonal (Klerman et al., 1984) theories have been developed and found quite effective. These treatments can be seen as first choice. Analysis can be an alternative for those patients who fail in these brief psychotherapies. On the other hand, most analysts consider severe depression with great functional impairment, delusions or melancholia a contra-indication for psychoanalysis. However, some analysts take a more liberal view of this (Jacobson, 1971).
The intermediate area between mild and severe depression is more difficult regarding indication for psychoanalysis. Lotz (1982) makes the following statement: “The indication for psychoanalysis … must depend on a total evaluation of the psychodynamic factors as well as the patient's other abilities for this kind of treatment. The biological aspect has to be evaluated and drug treatment possibly must be tried out.” Psychoanalysis