Not all that weeps is depression

doi:10.1136/bmj.b1503

Published 14 April 2009, doi:10.1136/bmj.b1503
Cite this as: BMJ 2009;338:b1503

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Depression severity scores

Not all that weeps is depression

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

Doctors listening to the chests of patients with left ventricularfailure will remember that not all that wheezes is asthma. Similarly,when low mood strikes our patients we need to remember thatnot all that weeps is depression. Adjustment disorders, bereavement,dysthymia, and borderline personality traits can all presentwith low mood, and are not depression but are easily mislabelled.

The hospital anxiety and depression scale (HADS), Beck depressioninventory (BDI), and 9 item patient health questionnaire (PHQ-9)are all markers of the severity of depression.¹ PHQ-9 and HADare also screening tools to judge the probability that depressionis present. They are not diagnostic tools. In particular thefragile labile mood and need for instant relief because of lowfrustration tolerance that feature in borderline personalitytraits can give very odd results with these tools. Often thescore is heavily shifted to the severe end.

In the study by . . . [Full text of this article]

Petre T C Jones, general practitioner¹

¹ The Project Surgery, London E13 0LN

Petre.JOnes@gp-f84750.nhs.uk

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