The empirical status of melancholia: Implications for psychology

Leventhal, Adam M.; Rehm, Lynn P.

doi:10.1016/j.cpr.2004.09.001

Cited by 89 publications

(49 citation statements)

References 134 publications

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“…Although Parker et al (1997) found that nonmelancholic depression was more closely linked to childhood adversity than melancholia, other studies have found no such relationship (Harkness and Monroe, 2002;Joyce et al, 2002). The results are similarly mixed with respect to the relationship between endogenous and melancholic depression, and current life events (Leventhal and Rehm, 2005).…”

contrasting

confidence: 42%

“…In the absence of neuroanatomical evidence definitively establishing a biological subtype, many researchers attempt to show differential associations between depression subtypes and social precipitants such stressful life events or childhood adversity. The results reported in the literature in this area are inconsistent (Katschnig et al, 1986;Leventhal and Rehm, 2005). Although Parker et al (1997) found that nonmelancholic depression was more closely linked to childhood adversity than melancholia, other studies have found no such relationship (Harkness and Monroe, 2002;Joyce et al, 2002).…”

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confidence: 44%

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The Development of Valid Subtypes for Depression in Primary Care Settings

Karasz¹

2008

Journal of Nervous &Amp; Mental Disease

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A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an "injured self." The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored. KeywordsDepression; explanatory model; subtypes; classification; conceptual models; illness representation A useful diagnostic system should indicate the etiology of an illness, guide treatment, predict outcomes, and, above all, reflect the structure of observed reality. It is a widely held view that the current classification system for depressive disorders falls short in each of these respects. Over the past few decades there have been serious attempts to rationalize the DSMs and increase their heuristic and pragmatic value. A persistent theme in this debate has been the question of how to distinguish biological depressions from depressions that are social in origin.The current classification system posits a "unitary" model of depression, distinguishing between different forms of the illness largely by severity (Parker, 2000). This model has reigned since the distinction between "reactive" and "endogenous" subtypes in the classification of depression fell out of favor in the late 1980s. After the disappointing failure of large-scale studies to validate the subtypes (Katschnig et al., 1986), they were subsequently omitted from DSM-III. Although a new category, "adjustment disorder," was added at this time, it has not proved useful. A "rule out" diagnosis that can be made only when the patient does not meet full criteria for depression, adjustment disorder is conflated with symptom severity, and is thus

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confidence: 42%

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confidence: 44%

The Development of Valid Subtypes for Depression in Primary Care Settings

Karasz¹

2008

Journal of Nervous &Amp; Mental Disease

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“…However, there is considerable evidence that depression is a complex set of features involving numerous intermediate phenotypes (e.g., anhedonia, vegetative symptoms, negative emotions), rather than a unitary homogenous syndrome (Hasler, Drevets, Manji, & Charney, 2004). Because different psychopathologic forms of depression are associated with distinct biological, psychological, and behavioral correlates and may have unique etiologies (Hasler et al, 2004;Leventhal & Rehm, 2005;Pizzagalli, Jahn, & O'Shea, 2005;Posternak & Zimmerman, 2002), it is difficult to understand mechanisms underlying the depression-smoking relationship by examining associations between smoking outcomes and depressive symptoms as a whole. Accordingly, evaluating whether certain dimensions of depressive symptoms have a greater influence on smoking cessation than others may clarify reasons for depression-smoking comorbidity (Pomerleau et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Dimensions of depressive symptoms and smoking cessation

Leventhal

Ramsey

Brown

et al. 2008

Nicotine & Tobacco Res.

201

198

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Because different psychopathologic components of depressive symptoms may have distinct etiologies, examining their differential effects on smoking cessation may elucidate mechanisms underlying the smoking-depression relationship. Negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP) have been identified as unique dimensions of depression that can be measured using the Center for Epidemiologic Studies Depression Scale (CESD). This study examined common and unique associations between CESD subscales and baseline smoking characteristics, nicotine withdrawal, and relapse in 157 participants enrolled in a smoking cessation trial for heavy social drinkers. Each dimension was univariately associated with negative and positive reinforcement smoking motives. Only SF had unique relations with tolerance smoking motives and univariate associations with nicotine dependence severity. Only PA predicted cessation-related changes in withdrawal symptoms on quit day. Analyses predicting abstinence at 8, 16, and 26 weeks post quit date showed that NA, SF, and PA each univariately predicted relapse, ps≤.0083. Only low PA predicted poorer outcomes incrementally to the other dimensions, even when controlling for level of nicotine dependence, smoking frequency, and history of major depression, p=.0018. Interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit.

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“…Debates on the categorical and dimensional views of classifying the depressive illness have been going on for years without resulting in a consensus. The question is whether the majority of patients can be classified as either black or white or whether the grays are predominant (1,2). Some theorists have proposed that depressive phenomenology is best accounted for by a number of continuous dimensions (dimensional-unitary hypothesis).…”

Section: Introductionmentioning

confidence: 99%