BMJ  2003;327:158-160 (19 July), doi:10.1136/bmj.327.7407.158

Education and debate

Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease

¹ History of Medicine Program, Faculty of Medicine, University of Toronto, Toronto ON, Canada M5G 1VJ, ² Department of Psychological Medicine, Imperial College Faculty of Medicine, St Mary's Campus, London W2 1PD

No new drugs for mood and anxiety disorders have reached the market for over a decade. Why is there so little innovation in a sector that accounts for the largest proportion by far of sales of psychiatric drugs?

The first 150 words of the full text of this article appear below.

The current division between anxiety and depression is increasingly recognised as inadequate. In the community, most mood disorders present as a combination of depression and anxiety. Yet the Food and Drug Administration in the United States, which has become the world bellwether of drug approval, indicates drugs either for major depression or for the various forms of anxiety recognised by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). As a result, the pharmaceutical industry is compelled to develop drugs for diagnoses that are of questionable clinical relevance. This is one reason for the big slowdown in drug discovery in psychiatric drugs. A return to the former unitary classification of mood and anxiety disorders as nervousness or cothymia might represent a way out of this blind alley.

Origins of the new system

In 1980, the American Psychiatric Association revised its standard system of diagnoses in the third edition of its diagnostic manual . . . [Full text of this article]

Who defines psychiatric diagnoses?

Slowdown in drug discovery

-->

Reasons for slowdown

Commerce and cothymia

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Separation of anxiety and depressive disorders: Normal rules of critical evaluation were presumably suspended

Roger L Weeks
BMJ 2003 327: 869. [Extract] [Full Text]

Separation of anxiety and depressive disorders: New tools will lead to more valid classification system

Michael B First and Darrel A Regier
BMJ 2003 327: 869-870. [Extract] [Full Text]

Separation of anxiety and depressive disorders: Maybe pharmaceutical failure has created culture of niche diagnosis

Michael Joffe
BMJ 2003 327: 870. [Extract] [Full Text]

The pleasures of deep reading

Richard Smith
BMJ 2003 327: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Langen, B., Egerland, U., Bernoster, K., Dost, R., Unverferth, K., Rundfeldt, C. (2005). Characterization in Rats of the Anxiolytic Potential of ELB139 [1-(4-Chlorophenyl)-4-piperidin-1-yl-1,5-dihydro-imidazol-2-on], a New Agonist at the Benzodiazepine Binding Site of the GABAA Receptor. J. Pharmacol. Exp. Ther. 314: 717-724 [Abstract] [Full text]  
• Flint, A. J. (2005). Anxiety and Its Disorders in Late Life: Moving the Field Forward. AJGP 13: 3-6 [Full text]  
• WEICH, S., ARAYA, R. (2004). International and regional variation in the prevalence of common mental disorders: do we need more surveys?. Br. J. Psychiatry 184: 289-290 [Full text]  
• Walker, B. F (2003). Risk of suicide remains high fifteen years after deliberate self-harm. Evid. Based Ment. Health 6: 106-106 [Full text]  
• Joffe, M. (2003). Separation of anxiety and depressive disorders: Maybe pharmaceutical failure has created culture of niche diagnosis. BMJ 327: 870-870 [Full text]  
• Weeks, R. L (2003). Separation of anxiety and depressive disorders: Normal rules of critical evaluation were presumably suspended. BMJ 327: 869-869 [Full text]  
• First, M. B, Regier, D. A (2003). Separation of anxiety and depressive disorders: New tools will lead to more valid classification system. BMJ 327: 869-870 [Full text]  

Rapid Responses:

Read all Rapid Responses

Depression and anxiety are poor concepts full stop

Sami Timimi
bmj.com, 18 Jul 2003 [Full text]

Get Real

Andrew J Smith
bmj.com, 19 Jul 2003 [Full text]

Anxiety and Depression - beyond Cothymia and drugs

Dr Peter G Harvey, et al.
bmj.com, 19 Jul 2003 [Full text]

No new drugs for mood and anxiety disorders ...

L S Lewis
bmj.com, 19 Jul 2003 [Full text]

The "Depression Gene"

Samuel A. Feldman, Ph.D.
bmj.com, 20 Jul 2003 [Full text]

Neuroses are not "very real" diseases

GH Hall
bmj.com, 21 Jul 2003 [Full text]

Blind alley or poor reasoning

Roger L Weeks
bmj.com, 22 Jul 2003 [Full text]

Depession and Anxiety

Graeme Mackenzie
bmj.com, 23 Jul 2003 [Full text]

Has pharmaceutical failure created the niche diagnosis culture?

Michael Joffe
bmj.com, 24 Jul 2003 [Full text]

Classifications in psychiatry,comorbidity of depression and anxiety

Detlef Degner, et al.
bmj.com, 25 Jul 2003 [Full text]

On classifications

Paul M Verheecke
bmj.com, 7 Aug 2003 [Full text]

Ghostwriting

Adam Jacobs
bmj.com, 31 Jul 2003 [Full text]

Don't shoot the messenger--lack of understanding about pathophysiology is the problem.

Michael B. First, et al.
bmj.com, 8 Aug 2003 [Full text]

Declaration of Interests

susanne stevens, et al.
bmj.com, 12 Aug 2003 [Full text]

We are responsible too.

Tanuj Sidhartha
bmj.com, 7 Aug 2005 [Full text]