Melancholic and reactive depression: A reappraisal of old categories

Jin Mizushima, Hitoshi Sakurai, Yuya Mizuno, Masaki Shinfuku, Hideaki Tani, Kazunari Yoshida, Chisa Ozawa, Asako Serizawa, Natsuko Kodashiro, Shinya Koide, Atsumi Minamisawa, Eisaku Mutsumoto, Nobuhiro Nagai, Sachiko Noda, Genichiro Tachino, Tatsuichiro Takahashi, Hiroyoshi Takeuchi, Toshiaki Kikuchi, Hiroyuki Uchida, Koichiro WatanabeHiroki Kocha, Masaru Mimura

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background: The dominant diagnostic model of the classification of depression today is unitarian; however, since Kurt Schneider (1920) introduced the concept of endogenous depression and reactive depression, the binary model has still often been used on a clinical basis. Notwithstanding this, to our knowledge, there have been no collective data on how psychiatrists differentiate these two conditions. We therefore conducted a survey to examine how psychiatrists in Japan differentiate patients with major depressive disorder who present mainly with melancholic features and those with reactive features.Methods: Three case scenarios of melancholic and reactive depression, and one-in-between were prepared. These cases were designed to present with at least 5 symptoms listed in the DSM-IV-TR with severity being mild. We have sent the questionnaires regarding treatment options and diagnosis for those three cases on a 7-point Likert scale (1 = "not appropriate", 4 = "cannot tell", and 7 = "appropriate"). Five hundred and two psychiatrists from over one hundred hospitals and community clinics throughout Japan have participated in this survey.Results: The melancholic case resulted significantly higher than the reactive case on either antidepressants (mean ± SD: 5.9 ± 1.2 vs. 3.6 ± 1.7, p < 0.001), hypnotics (mean ± SD: 5.5 ± 1.1 vs. 5.0 ± 1.3, p < 0.001), and electroconvulsive therapy (mean ± SD: 1.5 ± 0.9 vs. 1.2 ± 0.6, p < 0.001). On the other hand, the reactive case resulted in significantly higher scores compared to the melancholic case and the one- in-between cases in regards to psychotherapy (mean ± SD: 4.9 ± 1.4 vs. 4.3 ± 1.4 vs. 4.7 ± 1.5, p < 0.001, respectively). Scores for informing patients that they suffered from "depression" were significantly higher in the melancholic case, compared to the reactive case (mean ± SD: 4.7 ± 1.7 vs. 2.2 ± 1.4, p < 0.001).Conclusions: Japanese psychiatrists distinguish between major depressive disorder with melancholic and reactive features, and thus choose different treatment strategies regarding pharmacological treatment and psychotherapy.

Original languageEnglish
Article number311
JournalBMC Psychiatry
Publication statusPublished - 2013 Nov 16


  • Antidepressant
  • Diagnosis
  • Melancholic depression
  • Newcastle scale
  • Reactive depression

ASJC Scopus subject areas

  • Psychiatry and Mental health


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