Abstract
It has been believed that most patients of depression seen in the out-patient clinics of internal medicine respond well to the treatment by antidepressants and recover in a relatively short period of time. However, there are some cases whom it takes more than a year to recover, though antidepressants are effective. In this report, these patients are called prolonged cases of depression. Twenty-four prolomged cases (15 males, 9 females) of depression experienced in the Department of Imternal Medicine of Nagoya University Hospital from 1971 to 1975 were studied to make clear the condition and the mechanism of prolongation. Duration of therapy ranged from one to six years ; 1-2 years in 11 patients, 2-3 years in 8 patients, and more than 3 years in 5 patients. The prolonged cases of depression were divided into three types according to the course of depressive condition : (1) Partially recovered type ; most distinctiv signs and symptoms are obviously diminished but a state of slight depression is still present. (2) Hypochondriac type ; depressive signs and symptoms are obviously diminished but anxiousness and tension about indefinite symptoms are apparent. (3) Unstable type ; depressive signs and symptoms disappear completely but they reappear within three months after returning to jobs. Among the 24 cases, patients of partially recovered type were 8,hypochondriac type 10,and unstable type 6 respectively. As the background factors in these prolonged cases, moderate personality deviations such as emotional immaturity, suggestability, and self-display together with SHUCHAKU-SEIKAKU, hypochondriac attachment to the slight physical symptoms, non-adjustable familial and social troubles were detected. And above-mentioned personality deviations, situstions, and symptoms interacted one another to disturb recovery of the disease. With the lapse of time, irregular taking of antidepressant drugs came to be apparent in some cases, and this conditon seemed to be one of the factors of prolongation.
