Open Access Open Badges Research article

Melancholic and reactive depression: a reappraisal of old categories

Jin Mizushima1*, Hitoshi Sakurai1, Yuya Mizuno1, Masaki Shinfuku1, Hideaki Tani1, Kadunari Yoshida1, Chisa Ozawa1, Asako Serizawa1, Natsuko Kodashiro1, Shinya Koide1, Atsumi Minamisawa1, Eisaku Mutsumoto1, Nobuhiro Nagai1, Sachiko Noda1, Genichiro Tachino1, Tatsuichiro Takahashi1, Hiroyoshi Takeuchi1, Toshiaki Kikuchi12, Hiroyuki Uchida1, Koichiro Watanabe1, Hiroki Kocha1 and Masaru Mimura1

Author Affiliations

1 Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

2 Zama Mental Clinic, 5-1684-3 Iriya, Zama-shi, Kanagawa 252-0024, Japan

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BMC Psychiatry 2013, 13:311  doi:10.1186/1471-244X-13-311

Published: 16 November 2013



The dominant diagnostic model of the classification of depression today is unitarian; however, since Kurt Schneider (1920) introduced the concept of endogenous depression and reactive depression, the binary model has still often been used on a clinical basis. Notwithstanding this, to our knowledge, there have been no collective data on how psychiatrists differentiate these two conditions. We therefore conducted a survey to examine how psychiatrists in Japan differentiate patients with major depressive disorder who present mainly with melancholic features and those with reactive features.


Three case scenarios of melancholic and reactive depression, and one-in-between were prepared. These cases were designed to present with at least 5 symptoms listed in the DSM-IV-TR with severity being mild. We have sent the questionnaires regarding treatment options and diagnosis for those three cases on a 7-point Likert scale (1 = “not appropriate”, 4 = “cannot tell”, and 7 = “appropriate”). Five hundred and two psychiatrists from over one hundred hospitals and community clinics throughout Japan have participated in this survey.


The melancholic case resulted significantly higher than the reactive case on either antidepressants (mean ± SD: 5.9 ± 1.2 vs. 3.6 ± 1.7, p < 0.001), hypnotics (mean ± SD: 5.5 ± 1.1 vs. 5.0 ± 1.3, p < 0.001), and electroconvulsive therapy (mean ± SD: 1.5 ± 0.9 vs. 1.2 ± 0.6, p < 0.001). On the other hand, the reactive case resulted in significantly higher scores compared to the melancholic case and the one- in-between cases in regards to psychotherapy (mean ± SD: 4.9 ± 1.4 vs. 4.3 ± 1.4 vs. 4.7 ± 1.5, p < 0.001, respectively). Scores for informing patients that they suffered from “depression” were significantly higher in the melancholic case, compared to the reactive case (mean ± SD: 4.7 ± 1.7 vs. 2.2 ± 1.4, p < 0.001).


Japanese psychiatrists distinguish between major depressive disorder with melancholic and reactive features, and thus choose different treatment strategies regarding pharmacological treatment and psychotherapy.

Antidepressant; Diagnosis; Melancholic depression; Newcastle scale; Reactive depression