Goldstein And Harold Alan Pincus. Classification Of Depression: Research And Diagnostic Criteria

1 1 Classification of Depression: Research and Diagnostic Criteria: DSM-IV and ICD-10 Alan M. Gruenberg, Reed D. Goldstein and Harold Alan Pincus Abstract This chapter shall address the classification of depressive disorders and its evolution over the past 50 years. We shall present a brief historical overview of depressive disorders and describe the development of the current nomenclature as incorporated in the Diagnostic and Statistical Manual of Mental Diseases Fourth edition (DSM-IV) [1] and the International Classification of Diseases and Related Health Problems 10th edition (ICD-10) [2]. We will examine current controversies in the diagnosis of depression, and conclude with comments about the potential impact of new neurobiological and neurogenetic developments on the diagnosis of depression in the future. 1.1 Historical Framework The history of depressive disorders is described in detail by Jackson [3]. The experience of depression has plagued humans since the earliest documentation of human experience. Ancient Greek descriptions of depression referred to a syndrome of melancholia, which translated from the Greek means black bile. In humoral theory, black bile was considered an etiologic factor in melancholia. This Greek tradition referred to melancholic temperament which is comparable to our understanding of early onset dysthymic conditions or depressive personality. During the late 19th and early 20th centuries, phenomenologists increasingly used the term depression or mental depression to refer to the clinical syndrome of melancholia. Emil Kraepelin [4] distinguished mood which was dejected, gloomy, and hopeless in the depressive phase in manic-depressive insanity from the mood which was withdrawn and irritable in paranoia. In addition, Kraepelin distinguished depression which represented one pole of manic-depressive insanity from melancholia, which involves depression associated with fear, agitation, self-accusation and hypochondriacal symptoms. Biology of Depression. From Novel Insights to Therapeutic Strategies. Edited by Julio Licinio and Ma-Li Wong Copyright © 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim ISBN: 3-527-30785-0 1260vch01.pmd 1 10.01.2005, 11:43 2 1 Classification of Depression: Research and Diagnostic Criteria: DSM-IV and ICD-10 Our current classification systems stem from these important observations. The distinction between manic-depressive (bipolar) conditions and non-bipolar conditions remains a critically important objective. The treatments available for these distinct types of disorders are quite different. We continue to rely on best clinical observation, careful diagnostic interviewing and assessment, family history, and clinical course to make these distinctions. The evolution of formal classification systems is a 20th century phenomenon. The stated goals of any classification system are to ensure improved communication among clinicians, to enhance understanding of the disorders in question, and to promote more effective treatment. Depression researchers have struggled because of the heterogeneity of the depressive syndrome. Early neurobiological investigation of the biological markers, such as cortisol response or cerebrospinal fluid neurotransmitter metabolites thought to be important in the differentiation of depression, yielded few consistent findings. This likely represented the problem of diagnostic non-specificity in the individuals being investigated. The current classification systems hopefully promote better separation between major depressive disorders and bipolar disorder. More accurate separation between psychotic