Neurotic Depression: Signs, Symptoms, & Treatments

What Is Depression?

Depression is a common mental health ailment that affects approximately 16 million American adults annually, but it is treatable with professional help.^1,2

What Is Neurotic Depression?

Neurotic depression is a type of depression distinguished by depressive symptoms in someone who is emotionally unstable. Neurotic depression presents as depression, but with the added discomfort of a ruminative loop of negative and anxious thoughts. These thoughts then influence someone’s behavior, perception, and processing of emotions and experiences, often leading to general chaos, anxious avoidance, internalization, and disorientation.⁵

This form of depression is often exhibited in individuals suffering from major personality disorders, neuroticism, and substance use disorders.³

A Professional Will Not Diagnose Someone With Neurotic Depression

Neurotic depression is not considered one of the major subtypes of depression, as it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It was also removed from the 10th edition of the international classification of diseases (ICD-10).^1,2,4 Neurotic depression was replaced by persistent depressive disorder (dysthymia) and major depressive disorder, but there are nuanced differences in these presentations versus neurotic depression.⁴ These complex distinctions as well as overlap with other mental disorders create difficulty in pinpointing signs that are specific to neurotic depression.

Neurotic depression is unique to other mental health diagnoses in that it is intertwined with life circumstances and how these circumstances are processed.³ These issues may result in difficulty with daily tasks, heightened emotional reactivity and avoidance, substance abuse, fixation on negative experiences, and catastrophizing.^3,4,5,6 But these symptoms are exhibited in other diagnoses as well, including anxiety, depression, personality disorders, and high neuroticism. This is what makes neurotic depression difficult to pinpoint, and it may be the reasoning for its omission in more recent versions of the ICD and DSM.

Signs of Neurotic Depression

In general, the signs that someone is dealing with neurotic depression include a blended presentation of depressive and neurotic behaviors.^3,5,6 However, neurotic depression holds similarities and differences from non-neurotic depression, also known as melancholic depression.

Neurotic depression is similar to other types of depression in that the individual is experiencing sadness, hopelessness, and despair. However, it differs in that individuals are generally younger in age, more likely to attempt suicide, and demonstrate lower levels of melancholia, memory issues, and delusional thinking.^3,5 Individuals with neurotic depression are more likely to display anxiousness and less likely to show melancholic symptoms.^4,5

Typical signs that an individual is struggling with neurotic depression vs. melancholic depression include:¹

• General negative attitude and self-perception
• Increased suicidality in comparison to non-neurotic counterparts
• Emotional reactivity and maladaptive coping
• Comorbid diagnoses such as a personality disorder, mood disorder, and/or substance use disorder
• General life instability such as issues with relationships, finances, and work

Symptoms of Neurotic Depression

Neurotic depression involves a ruminative loop that can paralyze individuals and inhibit their ability to utilize coping skills and solution-focused thought processes. Long-term depression & anxiety and can yield neurotic symptoms.⁵

Common neurotic depression symptoms include:^3,4,5,6

• Anxiousness/anxiety
• Suicidality
• Internalization
• Heightened emotional reactivity
• Rumination
• Fixation on negative experiences/memories
• Maladaptive coping such as substance abuse
• Self-blame and ‘other’ blame
• Catastrophizing
• Negative/low mood
• Avoidance of triggering stimuli
• Life problems (relationships, finances, sense of purpose)
• Low self-esteem
• General life dissatisfaction
• Identity issues

Getting Treatment For Neurotic Depression

Treatment specific to neurotic depression consists of clinical therapy to help stop being neurotic, holistic intervention, and medication management. Presumably, due to the deterrence from the neurotic depression diagnosis, there is more research on treatment that dates prior to its omission.

Therapy

Anyone who is experiencing a negative thought loop and notices that their function is being impacted should talk to a therapist to help them learn emotional regulation. Whether it is neurotic depression or another mental health issue, it is essential to prioritize treatment and wellness.

There are many access points to professional support and depression therapy. One of the main distinguishing factors of neurotic depression is the higher levels of suicidal ideation (SI), so when you’re looking for a therapist, it is essential to find a provider who is experienced in treating and managing it.³

Medication

Medication management for depression can be highly effective. Multiple studies dating back to the 1970’s discuss the efficacy of medications such as benzodiazepines and trazodone being effective for the treatment of neurotic depression. Interestingly, a 1979 study found that medication intervention was effective on both the placebo group and the control group in relieving depression and anxiety symptoms.

Coping Mechanisms

Knowing how to treat depression is vital. These finding above suggest that neurotic symptoms may be soothed by belief and mindset changes, since the placebo group also improved.¹ Additionally, the implementation of exercise, specifically yoga, is shown to decrease the negative symptoms associated with both neuroticism and depression.^10,11,12

The History of the Term “Neurotic Depression”

A 1978 study identified six different meanings for the term neurotic depression and suggested that the diagnosis be retired due to its vagueness.⁷ This form of depression relies heavily on the presence of maladaptive processing and general life chaos, which may be the result of a comorbid diagnosis such as a personality disorder or a substance use disorder.

Furthermore, the argument is made that an individual who grows up in adverse circumstances would also fit the criteria for this diagnosis, creating doubt around its validity as a stand-alone diagnosis.³ More recently, however, researchers have circled back to the idea of neurotic depression and hypothesize that it may be the ‘missing link’ between depression and anxiety.⁵

A 2020 study that examined the connection between neuroticism and depression in Chinese adolescents found that there was a significant relationship between the two, and that high levels of neuroticism were a predictive factor in the manifestation of depressive symptoms.^6,8

Additionally, recent research has suggested that emotional regulation is the mediator between neuroticism and depression, highlighting that individuals who can access adaptive coping strategies to foster emotional regulation tend to experience lower levels of neuroticism and depression. These findings also highlight that maladaptive coping is linked to higher levels of neuroticism and depression.^6,8,9

Since neurotic depression is deeply linked to life circumstances and the processing of life experiences, individuals who experience adversity are not able to develop adaptive coping skills and maintain emotional regulation.³ They are more likely to engage in thoughts and behaviors that lead to chaos and instability, triggering more emotional dysregulation. This cycle showcases the symptoms and patterns associated with neurotic depression.

Final Thoughts on Neurotic Depression

Depression is a common mental health condition characterized by a group of symptoms that include general unhappiness, hopelessness, low energy, apathy, and fatigue.^1,2 Neurotic depression is a type of depression that includes depressive symptoms plagued by the addition of emotional instability, anxious and ruminative thoughts that result in impaired function.