Classification of Depressive States

Abstract

A uniform classification of depressive states is still far from being complete and generally accepted, although improved and expanding treatment modalities today require valid homogeneous groupings more urgently than ever before. Semantic clarification is needed regarding many terms, for instance that of psychotic depression which is used by many as being synonymous with endogenous. Many attempts of establishing solid categories of depression by sophisticated statistical analysis have failed to yield definitive results, although several independent studies of this kind have produced suggestive evidence for the existence of a type of depression that may be equated with the classic endogenous depression. However, most efforts to demonstrate a clear bimodal distribution of depressive states and establish a category of neurotic depression have failed. These difficulties have prompted such compromise diagnostic labels as endoreactive or endogenomorphous. Genetic research has contributed to the only unequivocal diagnosis in this field: that of bipolar depression. A distinction between necessary and sufficient depressive symptoms is being proposed in this paper; and Foulds and Bedford's category of dysthymic disorders, which includes anxiety and depression, opens an interesting new perspective. The time-honoured diagnosis of involutional melancholia will no longer be included in the new editions of DSM III and ICD9 which are now being prepared. Current active research into the pathophysiology of depression and the biochemical disorders associated with it are likely to produce in the near future biological criteria for diagnosis and prognosis of depression that will be more operational than the traditional clinical features.