Depression. Aaron T. Beck, M.D.

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      Adapted from Cassidy et al. 1957.

      (1) Psychological (58 percent): “depressed”; “I have nothing to look forward to”; “afraid to be alone”; “no interest”; “can’t remember anything”; “get discouraged and hurt”; “black moods and blind rages”; “I’m doing such stupid things”; “I’m all mixed up”; “very unhappy at times”; “brooded around the house.”

      (2) Localized medical (18 percent): “head is heavy”; “pressure in my throat”; “headaches”; “urinating frequently”; “pain in head like a balloon that burst”; “upset stomach.”

      (3) Generalized medical (11 percent): “tired”; “I’m exhausted”; “I feel all in”; “tire easy”; “jumpy most at night”; “I can’t do my work, I don’t feel strong”; “I tremble like a leaf.”

      (4) Medical and psychological (2 percent): “I get scared to death and can’t breath”; “stiff neck and crying spells.”

      (5) Medical, general and local (2 percent): “breathing difficulty . . . pain all over”; “I have no power. My arms are weak”; “I can’t work.”

      (6) No information (9 percent).

      The authors tabulated the percentages of the various symptom types that were named by manic-depressive patients and by medically sick controls (Table 2-1). It is worthy of note that a medical symptom, either localized or generalized, was reported by 33 percent of the manic-depressive patients and 92 percent of the medically sick controls.

Symptoms

      The decision as to which symptoms should be included here was made as a result of several steps. First, several textbooks of psychiatry and monographs on depression were studied to determine what symptoms have been attributed to depression by general consensus. Second, in an intensive study of 50 depressed patients and 30 nondepressed patients in psychotherapy, I attempted to tally which symptoms occurred significantly more often in the depressed than in the nondepressed group. On the basis of this tabulation, an inventory consisting of items relevant to depression was constructed and pretested on approximately 100 patients. Finally, this inventory was revised and presented to 966 psychiatric patients. Distributions of the symptoms reported in response to the inventory are presented in Tables 2-3–2-7.

      One of the symptoms, namely irritability, did not occur significantly more frequently in the depressed than in the nondepressed patients. It, therefore, has been dropped from the list. Incidentally, Cassidy and his coworkers² found that this symptom was more frequent in the anxiety neurotic group than in the manic-depressive group.

      Some of the symptoms often attributed to the manic-depressive syndrome are not included in the symptom descriptions in this chapter. For instance, fear of death was not included because it was not found to be any more common among the depressed patients than among the nondepressed in the preliminary clinical study. Cassidy, Flanagan, and Spellman² found, in fact, that fear of death occurred in 42 percent of patients with anxiety neurosis and only 35 percent of the manic depressives. Similarly, constipation occurred in 60 percent of the manic-depressive patients and 54 percent of the patients with hysteria. Consequently, this particular symptom does not seem to be specific to depression.

      Conventional nosological categories were not used in our analyses of the symptomatology. Instead of being classified according to their primary diagnoses, such as manic-depressive reaction, schizophrenia, anxiety reaction, and so on, the patients were categorized according to the depth of depression they exhibited, independently of their primary diagnoses. There were two major reasons for this. First, in our own studies as well as in previous studies, it was found that the degree of interjudge reliability was relatively low in diagnoses made according to the standard nomenclature. Consequently, any findings based on diagnoses of such low reliability would be of relatively dubious value. The interpsychiatrist ratings of the depth of depression, by contrast, showed a relatively high correlation (.87). Second, we found that the cluster of symptoms generally regarded as constituting the depressive syndrome occurs not only in disorders such as neurotic-depressive reaction and manic-depressive reaction but also in patients whose primary diagnosis is anxiety reaction, schizophrenia, obsessional neurosis, and so on. In fact, we have found that a patient with the primary diagnosis of one of the typical depressive categories may be less depressed than a patient whose primary diagnosis is, for example, schizophrenia or obsessional neurosis. The sample, therefore, was divided into four groups according to the depth of depression: none, mild, moderate, and severe.

      In addition to making the usual qualitative distinctions among the symptoms, I have attempted to provide a guide for assessing their severity. The symptoms are discussed in terms of how they are likely to appear in the mild, moderate, and severe states (or phases) of depression. This may serve as an aid to the clinician or investigator in making a quantitative estimate of the severity of depression. The tables may be used as a guide in diagnosing depression, since they show the relative frequency of the symptoms in patients who were considered to be either nondepressed, mildly depressed, moderately depressed, or severely depressed. The method for collecting the data on which the tables are based is described in greater detail in Chapter 10. The patient sample is described in Table 2-2.

TABLE 2-2. Distribution of Patients According to Race, Sex, and Depth of Depression

      TABLE 2-3. Frequency of Emotional Manifestations Among Depressed and Nondepressed Patients (%)

Emotional Manifestations

      The term emotional manifestations refers to the changes in the patient’s feelings or overt behavior directly attributable to his or her feeling states (Table 2-3). In assessing emotional manifestations, it is important to take into account the individual’s premorbid mood level and behavior, СКАЧАТЬ