The Development and Validity of Familial Subtypes in Primary Unipolar Depression

Primary unipolar depression may be divided into three familial subtypes. The first of these is depression spectrum disease (DSD). It is defined as an ordinary depression in an individual who has a family history of alcoholism and/or antisocial personality. Such a person may also have a family history of primary depression but none of mania. The second subtype is familial pure depressive disease (FPDD). This is a depression in an individual who has a family history of primary depression but no family history of alcoholism, antisocial personality, or mania. The third type is sporadic depressive disease (SDD). This is an ordinary depression in an individual who has no family history of alcoholism, antisocial personality, primary unipolar depression or mania. Sporadic depressive disease has a late age of onset, usually in the late 30s or early 40s, whereas familial pure depressive disease and depression spectrum disease have an onset in the early 30s. Depression spectrum disease manifests itself by a stormy personal life, particularly with marital difficulties. Multiple episodes are seen most frequently in familial pure depressive disease. The dexamethasone suppression test differentiates between the three groups with familial pure depressive disease usually showing abnormal suppression, depression spectrum disease rarely showing abnormal suppression and sporadic depressive disease showing abnormal suppression in around 4 0% of the cases. It is noteworthy that both depression spectrum disease and secondary depression rarely show abnormal suppression with the dexamethasone suppression test. Thus, they are similar in this way. Likewise, familial pure depressive disease and bipolar depression in the large majority of cases show abnormal suppression. Thus, they are similar.