The familial classification of primary unipolar depression: Biological validation of distinct subtypes

Abstract

FUNDAMENTAL PROBLEM in the study of affective disorders has been isolating relatively homogeneous groups of depressed patients. This type of separation is essential to studies of both the etiology and treatment of depression. The bipolar-unipolar and primary-secondary distinctions have proven to be useful classifications in this regard. However, even with these distinctions, the majority of depressed patients remain classified in the heterogeneous group of primary unipolar depression. Winokur’s* has demonstrated that primary unipolar depression can be reliably subclassified on the basis of family history. According to Winokur’s scheme, depressive spectrum disease (DSD) refers to those patients with unipolar depression who have a first-degree family member with alcoholism and/or antisocial personality. There may or may not be a family history of depression in these patients. Familial pure depressive disease (FPDD) applies to patients with a family history only of depression. Those patients without a family history of depression, alcoholism, or antisocial personality are considered to have sporadic depressive disease (SDD). In a hospital population, these subtypes accounted for 16%, 26%, and 45%, respectively, of the unipolar depressives. The remaining 13% could not be classified according to this scheme because either the family history was unknown or because there was a history of mania in a first-degree relative.’