An acute depression precipitated by an intensely distressing situation such as loss of a job, death of a loved person, or financial setback. The condition may last for weeks or months, but usually clears up in time with proper treatment. Neurotic depressive reactions of one degree or another account for an estimated 20 to 30 per cent of all psychoneurotic disorders.The appearance of the depressed individual is one of deep dejection and discouragement; his facial expression is dull and masklike. He complains that he feels apprehensive, cannot sleep well, and is unable to concentrate. These symptoms are usually accompanied by a reduced level of activity and initiative, decreased self-confidence, feelings of loneliness and helplessness, restricted interests, tenseness, vague hostility, loss of appetite, and various bodily complaints. Everyday tasks are performed with difficulty, and in extreme cases the patient may sit by himself, cease talking, and threaten suicide. Sometimes the suicidal threat is made to extract sympathy and attention from others, but it should always be taken seriously. Neurotic de- pressives, however, do not make actual suicidal attempts as often as psychotic depressives, and they do not manifest the retardation, agitation, and delusions which are usually found in psychotic depressives. A neurotic depression may in some cases progress to a psychotic depression.Neurotic depressives are predisposed to overreact to situations from which most individuals “bounce back.” Characteristically, they have low ego strength, little ability to tolerate stress,a rigid conscience, sensitivity to guilt feelings, and introversive tendencies. They are usually overdependent individuals who bottle up their anger or feelings of rebellion and blame themselves for failures and losses. Many of them, however, have hostile fantasies against people they love and depend upon, and feel so guilty about these feelings that if one of these people is hurt or killed, they feel inwardly responsible even when it is no fault of their own. In these cases the depression may be viewed as an “intropunitive reaction”—that is, a turning of hostility or anger against the self rather than outward. Psychoanalytic theory attributes the feelings of helpless dependency and loss of appetite (or in some cases excessive appetite) found in many depressive patients to fixation at the oral level of psychosexual development.Antidepressant drugs and supportive therapy are usually effective in relieving neurotic reactive depressions, although electroshock is sometimes applied as an emergency measure. Hospitalization may be necessary, particularly when there is an active danger of suicide. When the symptoms have been reduced to a manageable level, psychotherapy is introduced to help the patient change his neurotic patterns of adjustment. This treatment is usually successful, since the patient can clearly recognize the situations that produced the depression although he needs help in understanding why he overreacted.Illustrative Case: Hannah M., a fifty-year-old mother of two children, consulted a psychiatrist in private practice, seeking help for feelings of depression which she could not overcome. A divorc6e, she was living with her son and his wife in their comfortable home in the suburbs of a large eastern city.In discussing her background, Hannah tended to emphasize her general unhappiness, rather than to focus on relations with specific individuals. She was the youngest of seven children born to parents advanced in years, and was six years younger than the sibling closest to her in age. She always felt keenly that she was not wanted either by her parents or her siblings—especially her three sisters, who were expected to play a major role in caring for her as when she was a young child. Instead of being given a bedroom with the others in the family, Hannah was relegated to a cot in her father’s small study in the rear of the house. Eventually she was given the room abandoned by a brother who married, but when an older sister decided that she preferred Hannah’s new room to her own, Hannah was forced to trade, thus giving up what had been a symbol of her acceptance by the family. This incident seemed to Hannah to typify the lightness with which her feelings were regarded by her parents and siblings. She recalled also that her clothes were always the castoffs of her older sisters and that she was frequently told that she was ugly and stupid by members of the family.Hannah completed high school and just a few years later, after a year in secretarial school and two years in office work, married a man she didn’t know very well in an effort to establish a home of her own. Her husband proved to be an improvident person who couldn’t hold a job for any length of time, and who soon began to be unfaithful. Hannah had two sons in rapid succession, and the combination of the responsibility of caring for them, the austere life she had to lead, and her husband’s infidelity caused her to become very anxious and angry and to withdraw from interaction with friends and family. When this condition failed to clear up in a short time, her family doctor insisted that she take a vacation away from her family. She therefore went on a three-month visit to her favorite aunt who lived in a distant city. While away, Hannah’s children were left in the care of a sister, and, during this time, her youngest, a two-year-old boy, sustained a head injury when struck by an automobile— an accident which Hannah felt resulted in his later severe mental retardation. When she returned home, Hannah’s husband left her and filed for a divorce, which she did not contest. She then went to work as a secretary to support her family and man aged to provide enough to permit her oldest son to have a good education. Eventually her son became successful in the insurance business and, after he married, he insisted that his mother and younger brother, who needed much care, come and live with him and his wife.Hannah's current complaint had its onset about a year after her retarded child died. He suffered a lingering illness and was cared for devotedly by Hannah to the last She was overcome by fear and depression when he died and felt guilty for having to leave him years before when she was away for a rest. Hannah also began worrying that she was too much of a burden on others and went out of her way to avoid being an imposition or an expense to her older son. Her obsessive fear that she might harm someone made it impossible for Hannah to work and she slept poorly. Just before coming to the psychiatrist she began to think about committing suicide.In an interview Hannah appeared to be in acute distress. She cried and wrung her hands. A constant theme she expressed involved her not wanting to cause concern or to be a burden on her children. She was accepted for treatment and was seen in a series of sixteen supportive interviews. During this time she developed some insight into her problems and her depression subsided. Hannah was then able to plan more realistically and shortly after was able to return to work. (Zax and Strieker, 1963)

Cite this page: N., Sam M.S., "NEUROTIC DEPRESSIVE REACTION (Reactive Depression)," in, November 28, 2018, (accessed August 17, 2022).


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