Therapeutic strategies in atypical depression. A German perspective

Summary

In Germany a major distinction is made between endogenous and neurotic depression. While traditionally neurotic depression was seen as being amenable only to psychotherapy, there is an increasing tendency to treat neurotic patients presenting the full depressive syndrome with antidepressant drugs. Those psychiatrists who are aware of the concept of atypical depression in the stricter sense (anxiety-depression, depression with reversed somatic symptoms, etc) tend to treat these patients with monoamine oxidase inhibitors. The diagnosis of “dysthymia”, Possibly equivalent to “neurotic depression”, has not yet come into common usage. While the term “neurasthenia” is traditional, general Practitioners prefer other designations; treatment involves supportive psychotherapy, benzodiazepines and sedative antidepressants. Mixed anxiety-depression is treated with anxiolytic antidepressants, sedatives or, for the milder cases, with low-dose neuroleptics. This indication for neuroleptics is controversial, and a treatment protocol has been codified for use by the general practitioners so as to avoid the potential major adverse reactions seen with the class. The new concept of recurrent brief depression is confined to academic milieu, where treatment is the same as for unipolar depression.