To demonstrate that the dimension-weighted DSM-IV model for classifying the depressive disorders lacks utility.
Method:
The logical flaws in classifying the depressive disorders with any severity-based model (which underpin both the DSM-IV and ICD-10 systems) are noted. Integral definitional limitations to the DSM-IV definition of key depressive disorders are identified. It is argued that the DSM-IV classificatory system lacks utility for providing information on etiology and preferential management strategies. An alternative subtyping model is considered.
Results:
It is asserted that, in practice, the DSM-IV model and criteria lack explanatory power and compromise research and clinical practice.
Conclusions:
It is hoped that this article evokes wider debate about modelling and classifying the depressive disorders.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.Washington (DC): American Psychiatric Association; 1994.
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3th ed.Washington (DC): American Psychiatric Association; 1980.
3.
KirkSAKutchinsH.The myth of the reliability of DSM. J Mind Behav1994;15:71–86.
4.
AnthonyJCFolsteinMRomanoskiAJVon KorffMRNestadtGRChahalR, and others. Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Experience in eastern Baltimore. Arch Gen Psychiatry1985;42:667–75.
5.
HickieI.Issues in classification: III. Utilising behavioural constructs in melancholia research. In: ParkerGHadzi-PavlovicD, editors. Melancholia: A disorder of movement and mood. A phenomenological and neurobiological review. New York (NY): Cambridge University Press; 1996. p 38–56.
6.
ParkerG.Critique of the guidelines of the treatment of depression: Flaws in the construction. Aust N Z J Psychiatry2004;38:885–90.
7.
KirschIMooreTJScoboriaANichollsS.The Emperor's new drugs: An analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevention and Treatment2002;5:1–11.
8.
KhanAKhanSBrownWA. Are placebo controls necessary to test new antidepressants and anxiolytics?Int J Neuropsychopharmacol2002;5:193–7.
9.
de MelloMFde Jesus MariJBacaltchukJVerdeliHNeugebauerR.A systematic review of research findings of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci2005;255:75–82.
10.
HolmesJ.All you need is cognitive behaviour therapy. BMJ2002;324:288–94.
11.
ParkerG.Beyond major depression. Psych Med2005;35:467–74.
12.
GoldneyRD. The utility of the DSM nosology of mood disorders. Can J Psychiatry2006;51:874–8.
13.
ParkerG.Classifying depression: Should paradigms lost be regained?Am J Psychiatry2000;157:1195–1203.
14.
ParkerGManicavasagarV, editors. Modelling and managing the depressive disorders. Cambridge (UK): Cambridge University Press; 2005.
15.
ParkerGHadzi-PavlovicD, editors. Melancholia: A disorder of movement and mood. A phenomenological and neurobiological review. New York (NY): Cambridge University Press; 1996.
16.
MalhiGParkerGGreenwoodJ.Structural and functional models of depression: From sub-types to substrates. Acta Psychiatr Scand2005;111:94–105.
17.
SpikerDGWeissJDealyRGriffinSHaninINeilJ and others. The pharmacological treatment of delusional depression. Am J Psychiatry1985;142:430–6.
18.
ParkerGRoyKHadzi-PavlovicDPedicF.Psychotic (delusional) depression: A meta-analysis of physical treatments. J Affect Disord1992;24:17–24.
19.
ParkerGRoyKWilhelmKMitchellP.Assessing the comparative effectiveness of antidepressant therapies: A prospective clinical practice study. J Clin Psychiatry2001;62:117–25.
20.
ParkerG.MitchellPWilhelmKMenkesDSnowdonJSchweitzerI, and others. Are the newer antidepressant drugs as effective as established physical treatments? Results from an Australasian Clinical Panel Review. Aust N Z J Psychiatry1999;33:874–81.
21.
ParkerGManicavasagarVCrawfordJTullyLGladstoneG.Assessing personality traits associated with depression: The utility of a tiered model. Psychol Med2006;36:1131–9.
