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A Prospective Three- to Four-Year Follow-up Examination in Light of the Primary-Secondary and Unipolar-Bipolar Dichotomies

Hagop S. Akiskal, MD; Adib H. Bitar, MD; Vahe R. Puzantian, MD; Ted L. Rosenthal, PhD; Parks W. Walker, MD

Arch Gen Psychiatry. 1978;35(6):756-766.

Abstract
• One hundred patients with "mild" depressive states, variously referred to as "situational," "reactive," or "neurotic," were studied. During a three- to four-year prospective follow-up, 4% had developed bipolar I, 14% bipolar II, and 22% unipolar disorders with predominantly favorable social outcome. Most of the remainder were suffering from nonaffective disorders; in this group, intermittent depressive symptomatology followed a protacted course (paralleling the underlying disorder) with generally unfavorable outcome. Irrespective of diagnostic subtype, a "characterological" component occurring in 24% of the total sample appeared to predict unfavorable prognosis, including three suicides. The diagnostic usage of the concept of neurotic depression may no longer be clinically meaningful, since it lacks sufficient phenomenological characterization and refers to a heterogeneous group of disorders. The data suggest the merits of a biaxial approach to the nosology of depressive disorders whereby phenomenologically based affective diagnoses are qualified as to the presence or absence of character disorder.

Author Affiliations
From the Mood Clinic of the Affective Diseases Program, Department of Psychiatry (Drs Akiskal, Bitar, Puzantian, Rosenthal, and Walker), and the Department of Pharmacology (Dr Akiskal), University of Tennessee Center for the Health Sciences, Memphis, and the Department of Psychology, Memphis State University (Drs Akiskal and Rosenthal).

Footnotes
Accepted for publication Nov 29, 1977.

Reprint requests to Mood Clinic, UT Department of Psychiatry, 42 N Dunlap St, Memphis, TN 38103 (Dr Akiskal).

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