Depression is a complex diagnostic construct, applied to individuals with a particular set of symptoms among which the essential ingredients are a depressed mood and a loss of interest .
Depression as a diagnostic and clinically meaningful term has a short history. No one has claimed fame for coining it and, whoever he was, might not feel justified in introducing it. It is a term widely used, not only in psychopathology but also in economics, in meteorology, in life sciences and in several other areas of human exercise. In psychiatry, it has been used with variable meanings and over the years has gradually lost its initial semantic value.
All the varieties of emotional reactions to actual or anticipated loss, all feelings of distress and sorrow arising from the adversities and vicissitudes of life, have been associated with depression. The individual today views depression as a part of life experience, an unavoidable condition that everyone has to go through at least once in his or her lifetime, and considers it subject to self-cure by will power.
This attitude, by failing to distinguish between transient dysphoric loss-related emotional states and clinical depression leading to profound disturbance of mental and social functioning, is both misleading and hazardous.
In contrast to the normal emotional responses to unwanted and stressful events, clinical depression is a mental disorder which, due to its severity, its tendency to recur and its high cost for the individual and for society, is a medically significant condition that needs to be diagnosed and properly treated.
Names and terms have to convey a distinct meaning applicable only or principally to the things or the items they designate. This is not the case with the term “depression”. The proliferation of the term, with its use in multiple contexts, has considerably reduced its diagnostic specificity and its psychological meaning. The tenn “depressive disorders”, denoting the psychopathological nature of depression, may have lessened but has not removed the confusion.
It is to be hoped that, in the near future, more appropriate terms will be adopted that will satisfy taxonomic criteria based on single, psychologically meaningful, parent terms from which the subordinate subtypes will derive. “Thymos” might be considered as an appropriate candidate parent tenn for mood disorders in general and for depression (catathymia) in particular.
The elimination of the term “unipolar” from both DSM and ICD systems is largely justified, mainly due to the observation that there are latent bipolar cases occupying a significant part of the depressive spectrum. Patients diagnosed as unipolars in one or several past depressive episodes may turn out as bipolars even in late age, particularly if dysthymia preceded the major depressive episodes.
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