A phenomenological evaluation of the depressive disorder.

The term "depression" is frequently utilized in common language, but not al ways with the same meaning. This extended application is in part a conseque nce of the currently used communication systems which send information to a wide range of public regardless of its cultural, ethnic or educational bac kgrounds. It is also an expected result of what is conceived now as the new era of depression that arises both from the constant accumulation of knowl edge on the causes of this disorder, as well as from the quick development of different types of effective antidepressant medications. However, this h as produced a distortion in the utilization of the term and a frequent abus e and misuse of its meaning, including even its medical application. The ob jetive of this paper is to reevaluate the concept of depression in order to define more precisely its application for clinical and research purposes. For this purpose, a revision of the phenomenological evaluation of the conc ept is made. Most of the classification systems used actually in psychiatry , are based on a nosological description of the mental diseases which pay s pecial attention to its severity according to the number of symptoms simult aneously present in a defined period of time. This quantitative approach re flects only partially the real condition of the patients because the same n umber of symptoms might have different impact in the functional condition o f the subject, depending on other individual factors, and do not represent the same level of severity. In contrast, a qualitative approach improves th e diagnostic accuracy by providing the inclusion of manifestations that cle arly differentiate real depression states from other symptomatic conditions that have some depressive symptoms. This differentiation wild produce clin ical and research benefits by precisely defining depressive patients who de serve pharmacological intervention and also homogeneous groups to which res earch objectives could be directed. Three phenomenological concepts of major depression with endogenous feature s are revised: 1) Vital sadness or anhedonia is a nuclear feature of endoge nicity that has to be differentiated from other types of sadness present in other forms of depression; it is a condition that arises from the patient' s internal bodily system and is perceived as an emotional emptiness that ma kes the depressive person incapable of experiencing any form of pleasurable reactions. This symptom is frequently related to feelings that are difficu lt to express verbally and thus are manifested as somatic symptoms. 2) Psyc homotor inhibition is another core symptom of endogenicity. It is manifeste d as a reduction of motor expression that leads to apathy and lack of inter est. Thought with its verbal and corporal components is reduced to a minimu m in melancholic depression, inhibiting contact with the external world. Th is condition in its extreme severity generated catatonic slates, in which t he patient is incapable of taking care of himself. 3) A third component is a distortion of the perception of time. in depression there is a desyncroni zation of the patient's inner time, which seems to be evolving slowly and i s closely related to psychomotor inhibition. This distortion limits activty and the patient feels that everything around him (her) has stopped or is p assing in a slow and desperate manner. The perception of the future is affe cted and past memories ate fragmented. This aspect of the illness frequentl y contributes to suicidal thoughts. The phenomenological approach to endogenous depression is important conside ring that it can improve the diagnostic specificity that will result in a b etter classification of the disease for clinical, epidemiological or resear ch purposes.