Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Archives of Psychiatry and Clinical Neuroscience

01-03-2007 | ORIGINAL PAPER

The spectra of neurasthenia and depression: course, stability and transitions

Authors: Alex Gamma, Jules Angst, Vladeta Ajdacic, Dominique Eich, Wulf Rössler

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 2/2007

Login to get access

Abstract

Background

Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood.

Methods

In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account.

Results

The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22–41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low.

Conclusions

Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.
Literature
1.
Angst J (1992) Recurrent brief psychiatric syndromes of depression, hypomania, neurasthenia, and anxiety from an epidemiological point of view. Neurol Psychiatr Brain Res 1:5–12
2.
Angst J (1997) Recurrent brief psychiatric syndromes: hypomania, depression, anxiety and neurasthenia. In: Judd LL, Saletu B, Filip V (eds) Basic and clinical science of mental and addictive disorders. Karger, Basel Freiburg Paris, pp 33–38CrossRef
3.
Angst J, Gamma A, Ajdacic V, Eich D, Rössler W (2004) Prevalence and clinical significance of subthreshold mood disorders. Int J Neuropsychopharmacol 7:S50
4.
Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rössler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73:133–146PubMedCrossRef
5.
Angst J, Gamma A, Neuenschwander M, Ajdacic-Gross V, Eich D, Rössler W, Merikangas KR (2005) Prevalence of mental disorders in the Zurich cohort study: a twenty year prospective study. Epidemiol Psichiatr Soc 14:68–76PubMed
6.
Angst J, Gamma A, Sellaro R, Zhang H, Merikangas K (2002) Toward validation of atypical depression in the community: results of the Zurich cohort study. J Affect Disord 72:125–138PubMedCrossRef
7.
Angst J, Koch R (1991) Neurasthenia in young adults. In: Gastpar M, Kielholz P (eds) Problems of psychiatry in general practice. Neurasthenia. Obsessive-compulsive disorder. Advances in treatment of depression. Teaching and training of the GP. Hofgrefe & Huber Publishers, Lewinston Toronto Bern Göttingen, pp 37–48
8.
Beard GM (1869) Neurasthenia, or nervous exhaustion. Boston Med Surgical J 79:217–221
9.
Dana CL (1890–1891) Neurasthenia. Post-Graduate 6:26
10.
Demyttenaere K, De Fruyt J, Stahl SM (2005) The many faces of fatigue in major depressive disorder. Int J Neuropsychopharmacol 8:93–105PubMedCrossRef
11.
Diggle P, Heagerty P, Liang KY, Zeger S (2002) Analysis of longitudinal data. Oxford University Press, Oxford
12.
Dunner DL, Fleiss JL, Fieve RR (1976) The course of development of mania in patients with recurrent depression. Am J Psychiatry 133:905–908PubMed
13.
Farmer A, Fowler T, Scourfield J, Thapar A (2004) Prevalence of chronic disabling fatigue in children and adolescents. Br J Psychiatry 184:477–481PubMedCrossRef
14.
Fischer-Homberger E (1972) Hypochondriasis of the eighteenth century—neurosis of the present century. Bull Hist Med 46:391–401PubMed
15.
16.
Gosling FG (1987) Before Freud. Neurasthenia and the American Medical Community, 1870–1910. University of Illinois, Urbana Chicago
17.
Hickie I, Lloyd A, Wakefield D (1991) Comment to Kendell’s ‘Chronic fatique, viruses, and depression’. Lancet 337:922–923PubMedCrossRef
18.
Hotopf M, David AS, Hull L, Nikalaou V, Unwin C, Wessely S (2003) Gulf war illness—better, worse, or just the same? A cohort study. BMJ 327:1373PubMedCrossRef
19.
Maeno T, Kizawa Y, Ueno Y, Nakata Y, Sato T (2002) Depression among primary care patients with complaints of headache and general fatigue. Primary Care Psychiatry 8:69–72CrossRef
20.
Meier A (1985) Validierung des Depressions-Ratings im Fragebogen SPIKE an Patienten der Psychiatrischen Poliklinik. Medical thesis. University of Zurich
21.
Merikangas KR, Angst J (1994) Neurasthenia in a longitudinal cohort study of young adults. Psychol Med 24:1013–1024PubMedCrossRef
22.
Morey LC, Kurtz JE (1996) The place of neurasthenia in DSM-IV. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Wakefield Davis W (eds) DSM-IV Sourcebook. American Psychiatric Association, Washington D.C
23.
Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJM, Wessely SC (1994) Population based study of fatigue and psychological distress. Br Med J 308:763–766
24.
Roy-Byrne P, Afari N, Ashton S, Fischer M, Goldberg J, Buchwald D (2002) Chronic fatigue and anxiety/depression: a twin study. Br J Psychiatry 180:29–34PubMedCrossRef
25.
Sartorius N (1997) Diagnosis and classification of neurasthenia. In: Judd LL, Saletu B, Filip V (eds) Basic and clinical science of mental and addictive disorders. Bibliotheca Psychiatrica, Karger, Basel, pp 1–5CrossRef
26.
Schäfer ML (2002) Zur Geschichte des Neurastheniekonzeptes und seiner modernen Varianten Chronic-Fatigue-Syndrom, Fybromyalgie sowie Multiple Chemische Sensitivität. Fortschr Neurol Psychiat 70:570–582PubMedCrossRef
27.
Schäfer ML (1980) Zur nosologischen Entwicklung und Wechselbeziehung von Hypochondrie und Neurasthenie. In: Peters UH (eds) Die Psychologie des 20. Jahrhunderts. Band X. Ergebnisse für die Medizin. Kindler Verlag, Zürich, pp 757–769
28.
Sharpe MC, Archard L, Banatvala J, Borysiewicz LK, Clare AW, David A (1991) Chronic fatigue syndrome: guidelines for reasearch. J R Soc Med 84:118–121PubMed
29.
Shorter E (1992) Somatization at the end of the twentieth century. In: From paralysis to fatigue. A history of psychosomatic illness in the modern era. The free press, New York, p 295–322
30.
Steiner A (1964) Das nervöse Zeitalter. Der Begriff der Nervosität bei Laien und Ärzten in Deutschland und Österreich um 1900. In:University of Zurich
31.
Taylor RE (2001) Death of neurosthenia and its psychological reincarnation. A study of neurosthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870–1932. Br J Psychiatry 179:550–557PubMedCrossRef
32.
Üstün TB (1994) WHO collaborative study: an epidemiological survey of psychological problems in general health care in 15 centers worldwide. Int Rev Psychiatry 6:357–363
33.
van Deusen EH (1869) Observations on a form of nervous prostration (neurasthenia), culminating in insanity. Am J Insanit 25:445–461
34.
Walsh CM, Zainal NZ, Middleton SJ, Paykel ES (2001) A familiy history study of chronic fatigue syndrome. Psychiatr Genet 11:123–128PubMedCrossRef
35.
Watt T, Groenvold M, Bjorner JB, Noerholm V (2000) Fatigue in the Danish general population. Influence of sociodemographic factors and disease. J Epidemiol Commun Health 54:827–833CrossRef
36.
Wessely S (1997) Chronic fatigue syndrom: a 20th century illness? Scand J Work Environ Health 23:17–34PubMed
37.
Wessely S (1998) The epidemiology of chronic fatigue syndrome. Epidemiol Psichiatr Soc 7:10–24PubMed
38.
Wilson A, Hickie I, Hadzi-Pavlovic D, Wakefield D, Parker G, Straus SE, Dale J, McCluskey D, Hinds G, Brickman A, Goldenberg D (2001) What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Austr New Zeal J Psychiatry 35:520–527CrossRef
39.
World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. World Health Organization, Geneva
Metadata
Title
The spectra of neurasthenia and depression: course, stability and transitions
Authors
Alex Gamma
Jules Angst
Vladeta Ajdacic
Dominique Eich
Wulf Rössler
Publication date
01-03-2007
Publisher
Steinkopff-Verlag
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 2/2007
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-006-0699-6