I am not a depression researcher, but I came across the notion of 'situational depression' assumed to be tied to specific stressful or traumatic events. This idea seems to imply that other forms, or causes, of depression are 'non-situational' and thus fundamentally different. But is there any good reason to make such a distinction?
Edward Shorter has several publications on the history of psychiatric categorization and how it has changed over time, including depression. It does make sense to study if such a separation, which was historically so (ie. melancholia and exogenous depression), improves the caracterization of this condition, its contributing factors and reponse to psychopharmacology or/and psychotherapy.
Shorter E. The 25th anniversary of the launch of Prozac gives pause for thought: where did we go wrong? Br J Psychiatry. 2014;204:331-2. doi: 10.1192/bjp.bp.113.129916.
Isn't everything that affects a person (not just mental illness) a result partly of inborn vulnerability and partly of exposure to something. Then, to complicate things, the exposure can alter the vulnerability (enhance it or dampen it) and the vulnerability can make noxious exposure more likely than benign exposure (or vice versa).
I agree with Renzo Bianchi bur I would add three considerations. First, even if I think that depression ( endogenous or exogenous "situational" ) has usually some related triggers, we can observe depressions where you can find more biological features than in others ( early awakening, cortisol flattened response to desametasone, etc ), That has been reminded also by Freud in "Mourning and Melanconia" (1917). Second, the trigger situation can be conscious and inconscious. Third, depression can follow a manic state in bipolar disorder. In that case I would not look for a "depressive trigger" but for a biological predisposition that can react, indeed, a some external or psychological factors.
Jacob Strandell
I personally think that whether it is endogenous depression or exogenous,it is a "psychological program"problem.
Endogenous depression is a genetic psychological program ,it is activated in the acquired living environment.Exogenous depression is the"psychological program" in which patients establish depression in the acquired living environment.
There are similarities between the two"psychological programs".The former encountered the right environment and the program was started.The latter is a temporary depression program.
I have over 40 years BHC clinical experience. There was a time when DSM included "transient situational disturbances" w/ depressed or anxious moods. It also later included "adjustment d/o w/ depressed or anxious moods. The distinction between "endogenous" or "exogenous" is not clinically useful for me. Clinical depression is valid and so is CD within a bipolar phase of manic-depression. The risk of suicide is quite high in untreated or under-treated CD.
We also describe dysthymia (Eyore) and cyclothymia. So differential diagnostic analysis is critical.
Great ?,
Rich
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