Modes of Onset of Psychotic Depression

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Abstract
Eighty-one psychotic ("endogenous") depressions were studied to determine the mode of onset of the symptoms, using a graphic method. Four patterns emerged from this investigation: sudden onset (11); gradual onset (50); neurotic onset (14); and fluctuating onset (6). Groups 1, 2, and 3 were examined further to see if other differences could be found. The results seemed to indicate that group 1 (sudden onset) comprised illnesses that were separate and distinct from those of groups 2 and 3, corresponded to the depressed phased of manic-depressive psychosis, and were truly endogenous; while the depressions of groups 2 and 3 were mainly exogenous, and, though probably related to each other, showed different responses to antidepressive drugs, group 2 responding more consistently. A classification of psychotic depressive illnesses, based on the evidence presented, is set out.