An Epidemic of Depression - Psychiatric Times

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May 12, 2009
Psychiatric Times. Vol. 26 No. 6
From Our Readers

An Epidemic of Depression
Doug Berger, MD, PhD
Dr Berger is in private practice in Japan.
“An Epidemic of Depression” by Wakefield and Horwitz(Psychiatric Times, November 2008, page 44) raised the issue thatDSM does not take into account the context in which symptoms

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Depressive Symptoms After Lossarise for the diagnosis of MDD. The authors opine that theResponse: An Epidemic ofdiagnosis should require that symptoms be “excessive” orDepression“unreasonable” relative to the context in which they arise, and that“the efficacy of these medications for the treatment of normal

Psychiatrists Should Not Fall Backsadness is often overstated.”on DSM

This is really a discussion of whether first–episode reactive

The Lure of the Context-Dependent

depression should be considered a type of MDD, even if thePsychiatric Diagnosis

symptoms are considered “excessive” given the context.
(Certainly, persons with recurrent endogenous depression do not

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Depression or Major Loss, or Both?

need much stress to have a relapse). Some persons react to high stress levels and develop a disorder and some do not (it is now known thatholding the short form of the serotonin transporter gene is a risk factor for MDD).
While the authors note that a few symptoms of sadness related to “overwhelming” distress may be “too often treated as a mental disorder,”they do not operationally define “a few symptoms of sadness.” If the stress is “overwhelming,” then it makes sense that many persons will
succumb to MDD as a result. I think that most psychiatrists would only give an antidepressant to someone with a first episode of reactive
depression in which there are concerning cognitive and/or vegetative symptoms that persist despite psychotherapy; in this setting, they may
also consider a short course of a soporific or minor tranquilizer.
My vote is that each patient needs to be looked at individually and treated based on the clinical judgment of the physician, who should takepast and family history into account. Including criteria for excessive reaction to stress in DSM goes against the recent genetic and neuroscience
findings that support the clinical experience of MDD seen in a variety of stress contexts and may lead to a delay in medical intervention whenneeded.

http://www.psychiatrictimes.com/display/article/10168/1413504

2009/06/06

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http://www.psychiatrictimes.com/display/article/10168/1413504

2009/06/06