Objective: My purpose is to critically evaluate psychiatry's current approach to the diagnosis of depression.
Methods: I have closely examined trends in diagnosing depression, especially since DSM-III, and have considered alternative options.
Results/Conclusions: Psychiatric taxonomy is currently based on invalid nosological premises that have worked as a straitjacket for conceptual progress and related biological and psychopharmacological research. A fresh approach that replaces nosological analysis with the concepts of functionalisation and verticalisation is essential.
References
1.
Van PraagHMDiagnosing depression. Looking backward into the future. Psychiatric Development1989; 7:375–394.
2.
RushAJWeissenburgerJEMelancholic symptom features and DSM-IV. American Journal of Psychiatry1994; 151:489–498.
3.
FairchildCJRushAJVasavadaNGilesDEKhatamiM.Which depressions respond to placebo?Psychiatry Research1986; 18:217–226.
4.
Van PraagHMFaulty cortisol/serotonin interplay. Psychopathological and biological characterisation of a new hypothetical depression subtype (SeCA depression). Psychiatry Research1996; 65:143–157.
5.
Van PraagHMComorbidity (psycho-)analyzed. British Journal of Psychiatry1996; 168:129–134.
6.
Van PraagHMTwo-tier diagnosing in psychiatry. Psychiatry Research1990; 34:1–11.
7.
SherbourneCDWellsKBHaysRDRogersWBurnamMAJuddLLSubthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients. American Journal of Psychiatry1994; 151:1777–1784.
8.
JuddLLAkiskalHSPaulusMPThe role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. Journal of Affective Disorders1997; 45:5–18.
9.
AngstJMerikangasKRScheideggerPWickiW.Recurrent brief depression: a new subtype of affective disorder. Journal of Affective Disorders1990; 19:37–38.
10.
RobinsLNHelzerJECroughanJRatcliffKSNational institute of mental health diagnostic interview schedule. Archives of General Psychiatry1981; 38:381–389.
11.
RobinsLNWingJKWittchenHUThe composite international diagnostic interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry1988; 45:1069–1077.
12.
AnthonyJCFolsteinMRomanowskiAJComparison of the lay diagnostic interview schedule and a standardized psychiatric diagnosis. Archives of General Psychiatry1985; 42:667–675.
13.
HelzerJERobinsLNMcEvoyLTA comparison of clinical and diagnostic interview schedule diagnoses. Archives of General Psychiatry1985; 42:657–666.
14.
FavaGAThe concept of recovery in affective disorders. Psychotherapy and Psychosomatics1996; 65:2–13.
15.
KellerMBHirschfeldRMAHanksD.Double depression: a distinctive subtype of unipolar depression. Journal of Affective Disorders1997; 45:65–73.
16.
Van PraagHMMake believes in psychiatry or the perils of progress. New York: Brunner Mazel, 1992.
17.
Van PraagHMConcerns about depression. European Psychiatry1995; 10:269–275.
18.
Van PraagHMOver the mainstream: diagnostic requirements for biological psychiatric research. Psychiatry Research1997; 72:201–212.
