Depression should be managed like a chronic disease: What exactly is "depression"?

doi:10.1136/bmj.332.7550.1154-a

BMJ 2006;332:1154 (13 May), doi:10.1136/bmj.332.7550.1154-a

Letter

Depression should be managed like a chronic disease

What exactly is "depression"?

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

EDITOR—Scott implies that depression is always a timeless,free-standing, internally coherent, universally valid, pathologicalentity with a life of its own out there.¹ Classification systems(generally called international but in fact merely Western)provide definitions which seem to assume this. However, disclaimersin small print say in effect that diagnostic categories arenot facts of nature (as, say, a tree is) but cobbled togetherphenomena emerging as committee decisions. Indeed, it was notinevitable that depressed mood should be seen as the cardinalsymptom and name the whole syndrome. Other symptoms could havebeen used: sleep disorder syndrome or concentration and drivedisorder syndrome.

What is the evidence that depression is under-recognised andundertreated? Some might point to a few community surveys usingquantitative instruments supposedly tapping depression. Suchinstruments, with their demand characteristics and narrow focuson symptoms, generate inflated estimates of prevalence becauseof their structural . . . [Full text of this article]

Derek A Summerfield, honorary senior lecturer

Institute of Psychiatry, Maudsley Hospital, London SE5 8AP derek.summerfield@slam.nhs.uk