Primary psychogenic depression: a pathogenetic model based on impaired translation of the mobilizing impulse into action

Abstract

Objective The aim of this paper was to develop a theoretical, clinical, and psychobiological model of the pathogenesis of primary psychogenic depression and to substantiate an etiological approach to psychotherapy.

Method A theoretical analysis of psychodynamic, neurobiological, and clinical studies of depression was conducted, together with an analysis of clinical observations obtained in the course of applying Integrative Causal Psychotherapy to the treatment of depressive disorders.

Results The proposed model identifies the central pathogenetic mechanism of primary psychogenic depression is the chronic inability to translate into action the mobilizing impulse arising during attempts to satisfy fundamental psychological needs. In this context, chronic inhibition of action may contribute to fronto-limbic conflict and mesolimbic dopaminergic hypoactivity, potentially promoting learned helplessness, diminished agency, and the development of a persistent depressive symptom complex. Based on this model, key therapeutic targets are identified and a mechanism-based psychotherapeutic approach is proposed, aimed at restoring access to the mobilizing impulse and the capacity to act.

Conclusions The proposed model integrates psychodynamic and neurobiological perspectives on depression within a unified causal framework and may serve as a theoretical basis for the development of targeted psychotherapeutic interventions for primary psychogenic depression.