More and more people are being diagnosed with depression, and many people take antidepressants for what may look like depression, even though their condition does not actually meet the clinical criteria for depression. Because a diagnosis of depression requires meeting specific thresholds, some within mental health communities have begun to question whether or not the Diagnostic and Statistical Manual (DSM) thresholds for clinical and major depression are too low. In other words, do people with long bouts of sadness or episodic distress meet some criteria for depression but not others? And if so, does this mean that they should still receive a diagnosis and treatment for major depression (MDD)?
To explore this question, Jerome C. Wakefield of the Silver School of Social Work at New York University recently led a study examining the recurrence rates of individuals with disordered depression and major depression. Wakefield took individuals with depressive episodes that lasted less than two months without suicidal ideation, psychotic tendencies, or worthlessness and considered them as uncomplicated episodes. He also excluded individuals with mild episodes and those without melancholy. These three groups were then compared to individuals with symptoms of severely long episodes, psychosis, suicidal ideation, worthlessness, and melancholy to see how the rates of recurrence over several years differed between the uncomplicated, lower threshold participants and those with more extreme symptoms.
Wakefield found that the excluded participants had much lower rates of recurrence when compared to the other MDD participants. Specifically, uncomplicated participants had recurrence rates of 3.4% compared to 14.6% for complicated episodes. Mildly depressed participants had 9.6% rate of recurrence compared to 20.7% recurrence for severely depressed individuals. And those without melancholy had a 10.6% recurrence of symptoms compared to 19.2% recurrence for participants with melancholy.
Overall, Wakefield believes these findings show that although depressive symptoms may be present in many individuals, using recurrence rates may be a more accurate way to diagnose MDD and distinguish it from other mood issues not otherwise specified. For those with MDD, treatments can be focused on reducing the most severe clinical symptoms. “Alternatively,” added Wakefield, “Treatment guidelines should emphasize stepped treatment, in light of the dramatic differences in prognosis between uncomplicated and other MDD.”
Wakefield, Jerome C., and Mark F. Schmitz. (2013). When does depression become a disorder? Using recurrence rates to evaluate the validity of proposed changes in major depression diagnostic thresholds. World Psychiatry 12.1 (2013): 44-52. 7 Mar. 2013. Web.
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