In an Editorial in the American Journal of Psychiatry the author recommends the use of five psychological symptoms of depression as sufficient for the diagnosis of Major Depression. Diagnosing Major Depression on the basis of a restricted symptom set.
Moreover, the justification for this restriction according to the author, is based on studies that showed that psychiatry and primary care trainees could not remember the nine symptoms.
That's why they are trainees
He replicated the findings of Zimmerman et al, using the 12 month version of the Composite International Diagnostic Interview (CIDI), famous for the inclusion of false positivies.
In the process this also means loosing classifications such as atypical or psychotic or melancholic depression. Diagnosing major depression has serious consequences, not a trifle matter. It could mean prescribing antidepressants for months, admittance or even other major interventions.
Dr Shock is not very keen on this development, what do you think?
Symptoms proposed, three or more of these five should be enough according to the author:
1. Depressed mood
2. Lack of interest
4. Poor concentration
5. Thoughts of Death
They used data from the 10,641 respondents to the Australian National Survey of Mental Health and Well-Being (free full text), which used the 12-month version of the Composite International Diagnostic Interview, Version 2.1. Nineteen percent of respondents reported 2 weeks of either depressed mood or loss of interest in the past 12 months, and all of these respondents were asked questions about every DSM-IV symptom for criterion A of major depressive disorder. Six percent met criteria for major depressive disorder during the year; one-half were current cases. The first replication included all respondents and showed 99.6% agreement between the full and restricted definitions. The large number without major depressive disorder could have inflated the measures of agreement. In order to recreate the clinical characteristics of the Zimmerman et al. sample, we focused on the 1,013 people from the Australian survey who met criteria for current mood, anxiety, or substance use disorders. This second replication (Table 1) showed 96.8% agreement between the full and restricted definitions. Substantially the same people were diagnosed by the full and restricted definitions in both replications.
Related posts on this blog:
Depression doesn't exist
In the BMJ
Is Depression overdiagnosed?
Andrews, G., Slade, T., Sunderland, M., Anderson, T. (2007). Issues for DSM-V: Simplifying DSM-IV to Enhance Utility: The Case of Major Depressive Disorder. American Journal of Psychiatry, 164(12), 1784-1785. DOI: 10.1176/appi.ajp.2007.07060928