Vol 10, N°3 Dialogues in Clinical Neuroscience - The Core of Depression
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ear Colleagues, Depressive ideation, the “symptoms” of depression, the “syndrome” of depression, the “illness” of depression; these all represent approaches to what are commonly known as depressive states.Yet, though the precipitating factor, the circumstances of the onset, and the type and intensity of symptoms may vary from one state to the other, we are still able to dis- tinguish a set of signs and symptoms which make up the “core” of depression. It is important to be able to identify these core features, and to describe them in terms of the context in which they occur, their severity, and their duration, in order to create a pro- file of the depressive state. It is also clear that the psychological aspects of personality assume major significance in terms of the severity of the disease and the resulting therapeutic choices.That is, the prog- nosis of a depressive state will certainly not be the same in a phobic personality as it would be in an obsessive personality. Another often-neglected aspect is the duration of treatment required to exert a cura- tive action on the disease; the pathology can be event-related, and manifest as a reaction to this event, whether this reaction is to an occurrence exterior to the subject, or to an inter- current illness (comorbidity?). However, some depressive states are linked to features inher- ent in the subject him- or herself; personality traits, or a particular genetic makeup (eg, the depressive phase of bipolar disorder). In the latter case, it is obvious that the treatment must take into account the chronic dimension of the illness. Long-term treatments need to be as acceptable as possible to the patient. In particu- lar, the cognitive repercussions of certain treatments should be avoided. We felt that it would be useful to readdress the fundamental symptoms of depressive states, and to ask internationally renowned experts for their opinions in this field. We would like to warmly thank Rajesh Parikh and Marc-Antoine Crocq, as well as all of the authors of this issue, for their efforts in increasing our knowledge and awareness of a complex subject. Sincerely yours, Jean-Paul Macher, MD E d i t o r i a l D