 
Article Date: 07 Dec 2010 – 1:00 PST
It is unlikely that different types of depression (primary versus secondary, diverse baseline scores on HAM-D) can be combined to one single disease called Major Depression. When testing the efficacy of antidepressants or psychotherapy, clinicians should make an attempt to specify the subtypes of depression and to combine antidepressants and psychotherapy (which should be much more mode-specific) in a sequential approach.
In the current issue of Psychotherapy and Psychosomatics, Professor Per Bech (Hillerod, DK) presents an innovative method for classifying depression in relation to response to treatment.
The official DSM-IV diagnosis of major depression, which is based on a cluster of symptoms, does not provide any information about the specific symptoms presented by the patient in question (e.g. typical versus atypical depression) and no information about aetiological factors (e.g. primary depression or depression secondary to stress or another medical condition). Medical disorders are conventionally classified on the basis of symptomatology, pathophysiology and aetiology. As the pathophysiological mechanism in depression is still unknown, the validity of DSM-IV major depression as a medical disorder is problematic. The severe primary depressive conditions (psychotic and bipolar depression) are considered to be the most typically medical disorders due to their genetic loadings but these conditions are excluded from the placebo-controlled trials of antidepressants.
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