To the Editor.
—In his interesting In Perspective on neurasthenia, Dr Martensen1 omits depression as a latter-day explanation for "living on a plane lower than normal." While depressive disorder was certainly recognized a century ago2 and distinguished from neurasthenia, as recently as 1973 a leading psychiatric textbook noted that "[m]oderate depression is the rule" in neurasthenia.3 Today, one sees an increasing number of patients seeking antidepressant medication for increasingly mild or vague symptoms—fatigue, exhaustion, weariness, mild headache, premenstrual syndrome, poor concentration, grumpiness, even a messy desktop. What Love4 and Beard called neurasthenia, we sometimes call minor depression, dysthymia, depression not otherwise specified, or adjustment disorder with depressed mood. And when a patient denies depression but has symptoms of hypochondriasis, somatoform disorder, or even chronic fatigue, one also considers treatment with antidepressants. While Love and Beard called neurasthenia a disorder of the "upper crust," Hollingshead and Redlich
Trautman PD, Vielma VM. The Legitimacy of Neurasthenia. JAMA. 1994;272(22):1719. doi:10.1001/jama.1994.03520220013004