Therapy-Resistant Depressions: Symptoms and Syndromes: Contibutions to Symptomatology and Syndromes

Summary

1. Symptomatological, or syndromic predictors capable of replication do not exist for relative resistance to therapy. Even the ‘unimproved’ cases generally show a reduction in symptom intensity and a levelling-out of the symptomatology.

2. “Absolute” resistance to therapy is found in chronically evolving depressive courses. From the standpoint of symptomatology, it is characterized by a reduction in the number of symptoms, which must be defined for the individual patient; in addition, it is characterised by qualitative changes in the overall picture; i.e., rigidity, monotony and the like can be noted. Simultaneously, one observes marked inter-individual differences of the depressive personality as a whole, as well as large differences in the system of arousability. In chronic evolution, therefore, syndromic compilation of symptoms is exceedingly difficult.

3. Reduction of the remaining symptoms and simultaneous reinforcement of these symptoms; the greater inter-individual differences in the overall impression of chronically evolving depressive patients, as well as the marked responsiveness of arousability to meaningful stimuli demonstrable in individual patients, can be interpreted as secondary conditioning of depressive behavior at the level of the second-signal system, thus shifting the question of therapy from pharmacological measures to measures of behavioral therapy.