Vital exhaustion and depression: a conceptual study

Excess fatigue, hopelessness, listlessness, loss of libido, increased irritability and problems with sleep have been found to increase the risk for a first non-fatal MI. These complaints are thought to reflect a state of 'vital exhaustion'. Most, if not all, of these feelings are also characteristic for subjects suffering from a depressive disorder. The aim of the present study was to explore whether a state of vital exhaustion is characterized more by depressed mood than by loss of vigour and excess fatigue. The Profile of Mood States was used to assess depressed mood, vigour and fatigue. Subjects monitored these factors themselves for a period of three weeks to circumvent retrospective recall bias and to investigate depressed mood, vigour and fatigue in a natural context. Current affective, cognitive, motivational and somatic symptoms of depression were further assessed retrospectively with the Beck Depression Inventory. The results with self-monitoring indicate that exhausted subjects suffer from loss of vigour and excess fatigue, while a depressed mood was almost absent. The retrospective assessment of symptoms of depression yielded similar results. It appeared that the most frequently reported symptoms were: 'fatigability', 'work inhibition', 'sleep disturbance' and 'loss of libido', while 'depressed mood', the key symptom for depressive disorders, was hardly mentioned. Based upon these results, we suggest that what we term 'vital exhaustion' is distinct from depression.