BMJ  2003;327:869-870 (11 October), doi:10.1136/bmj.327.7419.869-b

Letter

Separation of anxiety and depressive disorders

New tools will lead to more valid classification system

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

EDITOR—Shorter and Tyrer's comments about the implications of separating depressive and anxiety disorders in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) are perplexing, but not enlightening.1

Implying that this separation is impeding the development of new antidepressants, the authors cite an inverse relation between the number of patented new drugs and the number of DSM categories, then acknowledge that this association may not be causal. They call for companies to develop drugs targeting the heterogeneous category of mixed anxiety and depression but ignore the added cost resulting from the huge sample sizes of patients that would be needed to see even small drug effects.

Finally, the authors incorrectly assert that the drug industry significantly influences the diagnostic revision process. No facet of the DSM-IV revision process entailed any pharmaceutical company support.

We contend that the Food and Drug Administration's approval of compounds for . . . [Full text of this article]

Michael B First, associate professor of clinical psychiatry

Columbia University, 1051 Riverside Drive, Unit 60, New York, NY 10032, USA mbf2@columbia.edu

Darrel A Regier, director, division of research

American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209, USA


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Relevant Article

Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease
Edward Shorter and Peter Tyrer
BMJ 2003 327: 158-160. [Extract] [Full Text] [PDF]

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