The spectra of neurasthenia and depression: course, stability and transitions

  • Alex GammaEmail author
  • Jules Angst
  • Vladeta Ajdacic
  • Dominique Eich
  • Wulf Rössler



Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood.


In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account.


The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22–41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low.


Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.


neurasthenia depression prevalence course comorbidity spectrum 



This work was supported by Grant 3200–050881.97/1 of the Swiss National Science Foundation.


  1. 1.
    Angst J (1992) Recurrent brief psychiatric syndromes of depression, hypomania, neurasthenia, and anxiety from an epidemiological point of view. Neurol Psychiatr Brain Res 1:5–12Google Scholar
  2. 2.
    Angst J (1997) Recurrent brief psychiatric syndromes: hypomania, depression, anxiety and neurasthenia. In: Judd LL, Saletu B, Filip V (eds) Basic and clinical science of mental and addictive disorders. Karger, Basel Freiburg Paris, pp 33–38CrossRefGoogle Scholar
  3. 3.
    Angst J, Gamma A, Ajdacic V, Eich D, Rössler W (2004) Prevalence and clinical significance of subthreshold mood disorders. Int J Neuropsychopharmacol 7:S50Google Scholar
  4. 4.
    Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rössler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73:133–146PubMedCrossRefGoogle Scholar
  5. 5.
    Angst J, Gamma A, Neuenschwander M, Ajdacic-Gross V, Eich D, Rössler W, Merikangas KR (2005) Prevalence of mental disorders in the Zurich cohort study: a twenty year prospective study. Epidemiol Psichiatr Soc 14:68–76PubMedGoogle Scholar
  6. 6.
    Angst J, Gamma A, Sellaro R, Zhang H, Merikangas K (2002) Toward validation of atypical depression in the community: results of the Zurich cohort study. J Affect Disord 72:125–138PubMedCrossRefGoogle Scholar
  7. 7.
    Angst J, Koch R (1991) Neurasthenia in young adults. In: Gastpar M, Kielholz P (eds) Problems of psychiatry in general practice. Neurasthenia. Obsessive-compulsive disorder. Advances in treatment of depression. Teaching and training of the GP. Hofgrefe & Huber Publishers, Lewinston Toronto Bern Göttingen, pp 37–48Google Scholar
  8. 8.
    Beard GM (1869) Neurasthenia, or nervous exhaustion. Boston Med Surgical J 79:217–221Google Scholar
  9. 9.
    Dana CL (1890–1891) Neurasthenia. Post-Graduate 6:26Google Scholar
  10. 10.
    Demyttenaere K, De Fruyt J, Stahl SM (2005) The many faces of fatigue in major depressive disorder. Int J Neuropsychopharmacol 8:93–105PubMedCrossRefGoogle Scholar
  11. 11.
    Diggle P, Heagerty P, Liang KY, Zeger S (2002) Analysis of longitudinal data. Oxford University Press, OxfordGoogle Scholar
  12. 12.
    Dunner DL, Fleiss JL, Fieve RR (1976) The course of development of mania in patients with recurrent depression. Am J Psychiatry 133:905–908PubMedGoogle Scholar
  13. 13.
    Farmer A, Fowler T, Scourfield J, Thapar A (2004) Prevalence of chronic disabling fatigue in children and adolescents. Br J Psychiatry 184:477–481PubMedCrossRefGoogle Scholar
  14. 14.
    Fischer-Homberger E (1972) Hypochondriasis of the eighteenth century—neurosis of the present century. Bull Hist Med 46:391–401PubMedGoogle Scholar
  15. 15.
    Freudenberger HJ (1974) Staff burn-out. J Social Issues 30:159–165CrossRefGoogle Scholar
  16. 16.
    Gosling FG (1987) Before Freud. Neurasthenia and the American Medical Community, 1870–1910. University of Illinois, Urbana ChicagoGoogle Scholar
  17. 17.
    Hickie I, Lloyd A, Wakefield D (1991) Comment to Kendell’s ‘Chronic fatique, viruses, and depression’. Lancet 337:922–923PubMedCrossRefGoogle Scholar
  18. 18.
    Hotopf M, David AS, Hull L, Nikalaou V, Unwin C, Wessely S (2003) Gulf war illness—better, worse, or just the same? A cohort study. BMJ 327:1373PubMedCrossRefGoogle Scholar
  19. 19.
    Maeno T, Kizawa Y, Ueno Y, Nakata Y, Sato T (2002) Depression among primary care patients with complaints of headache and general fatigue. Primary Care Psychiatry 8:69–72CrossRefGoogle Scholar
  20. 20.
    Meier A (1985) Validierung des Depressions-Ratings im Fragebogen SPIKE an Patienten der Psychiatrischen Poliklinik. Medical thesis. University of ZurichGoogle Scholar
  21. 21.
    Merikangas KR, Angst J (1994) Neurasthenia in a longitudinal cohort study of young adults. Psychol Med 24:1013–1024PubMedCrossRefGoogle Scholar
  22. 22.
    Morey LC, Kurtz JE (1996) The place of neurasthenia in DSM-IV. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Wakefield Davis W (eds) DSM-IV Sourcebook. American Psychiatric Association, Washington D.CGoogle Scholar
  23. 23.
    Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJM, Wessely SC (1994) Population based study of fatigue and psychological distress. Br Med J 308:763–766Google Scholar
  24. 24.
    Roy-Byrne P, Afari N, Ashton S, Fischer M, Goldberg J, Buchwald D (2002) Chronic fatigue and anxiety/depression: a twin study. Br J Psychiatry 180:29–34PubMedCrossRefGoogle Scholar
  25. 25.
    Sartorius N (1997) Diagnosis and classification of neurasthenia. In: Judd LL, Saletu B, Filip V (eds) Basic and clinical science of mental and addictive disorders. Bibliotheca Psychiatrica, Karger, Basel, pp 1–5CrossRefGoogle Scholar
  26. 26.
    Schäfer ML (2002) Zur Geschichte des Neurastheniekonzeptes und seiner modernen Varianten Chronic-Fatigue-Syndrom, Fybromyalgie sowie Multiple Chemische Sensitivität. Fortschr Neurol Psychiat 70:570–582PubMedCrossRefGoogle Scholar
  27. 27.
    Schäfer ML (1980) Zur nosologischen Entwicklung und Wechselbeziehung von Hypochondrie und Neurasthenie. In: Peters UH (eds) Die Psychologie des 20. Jahrhunderts. Band X. Ergebnisse für die Medizin. Kindler Verlag, Zürich, pp 757–769Google Scholar
  28. 28.
    Sharpe MC, Archard L, Banatvala J, Borysiewicz LK, Clare AW, David A (1991) Chronic fatigue syndrome: guidelines for reasearch. J R Soc Med 84:118–121PubMedGoogle Scholar
  29. 29.
    Shorter E (1992) Somatization at the end of the twentieth century. In: From paralysis to fatigue. A history of psychosomatic illness in the modern era. The free press, New York, p 295–322Google Scholar
  30. 30.
    Steiner A (1964) Das nervöse Zeitalter. Der Begriff der Nervosität bei Laien und Ärzten in Deutschland und Österreich um 1900. In:University of ZurichGoogle Scholar
  31. 31.
    Taylor RE (2001) Death of neurosthenia and its psychological reincarnation. A study of neurosthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870–1932. Br J Psychiatry 179:550–557PubMedCrossRefGoogle Scholar
  32. 32.
    Üstün TB (1994) WHO collaborative study: an epidemiological survey of psychological problems in general health care in 15 centers worldwide. Int Rev Psychiatry 6:357–363Google Scholar
  33. 33.
    van Deusen EH (1869) Observations on a form of nervous prostration (neurasthenia), culminating in insanity. Am J Insanit 25:445–461Google Scholar
  34. 34.
    Walsh CM, Zainal NZ, Middleton SJ, Paykel ES (2001) A familiy history study of chronic fatigue syndrome. Psychiatr Genet 11:123–128PubMedCrossRefGoogle Scholar
  35. 35.
    Watt T, Groenvold M, Bjorner JB, Noerholm V (2000) Fatigue in the Danish general population. Influence of sociodemographic factors and disease. J Epidemiol Commun Health 54:827–833CrossRefGoogle Scholar
  36. 36.
    Wessely S (1997) Chronic fatigue syndrom: a 20th century illness? Scand J Work Environ Health 23:17–34PubMedGoogle Scholar
  37. 37.
    Wessely S (1998) The epidemiology of chronic fatigue syndrome. Epidemiol Psichiatr Soc 7:10–24PubMedGoogle Scholar
  38. 38.
    Wilson A, Hickie I, Hadzi-Pavlovic D, Wakefield D, Parker G, Straus SE, Dale J, McCluskey D, Hinds G, Brickman A, Goldenberg D (2001) What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Austr New Zeal J Psychiatry 35:520–527CrossRefGoogle Scholar
  39. 39.
    World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. World Health Organization, GenevaGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Alex Gamma
    • 1
    Email author
  • Jules Angst
    • 1
  • Vladeta Ajdacic
    • 1
  • Dominique Eich
    • 1
  • Wulf Rössler
    • 1
  1. 1.Research DepartmentZurich University Psychiatric HospitalZurichSwitzerland

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