Definition of "clinical depression" ?
Q.I am a little confused about the definition of "clinical depression". Based on my personal experiences it has to be either: 1. Fatigue the cause of which does not show up on a the following tests: Chem 20, CBC, thyroid panel, and sed rate. 2. The condition of having an MD say: "You are depressed". Which of these are the correct definition?
A.No, definitely not. Depression is a psychiatric (psychological) disease that is a syndrome of characteristic mental function alteration. Certainly these tests could be useful to diagnose a disease that might mimic depression, but absence of organic disease in the presence of fatigue is totally insufficient for a diagnosis. Are you claiming that when an M.D. makes a diagnosis of depression that he/she is ALWAYS correct and that if the patient thinks that they are not depressed they are in denial? Hang on. There are plenty of issues where a refined diagnosis predicts prognosis, probability of treatment success, etc. For example, paedophiles attracted to males are significantly less likely to benefit from treatment than paedophiles attracted to females. Making the distinction part of the diagnostic code is, to my knowledge, unique to DSM. Yeah. Suicide rate in the general community is less than 1% per lifetime. Suicide rate in depression is 10-15%. Suicide rate in bipolar disorder is ~25%. That's in Australia. It's probably different in the US, where suicide is more common overall. If a person satisfies the DSM criteria for depression, I'd say there's a 99.5% chance that the person has the same disease as those people who are diagnosed with 'depression'. Part of the diagnostic criteria is that the symptoms are not better accounted for by a general medical illness, or by another psychiatric illness. If the person is a doctor: Take a full history from the patient, complete a full examination, investigate the patient as necessary to establish that there is no organic basis for the symptoms (like anaemia, hypothyroidism, etc). Whip out the list, and ask the specific questions in order. I know I do. The physicians are most amused when I give them a score out of 7 for the patient's depressive symptoms. Unlike most people, I screen most patients for depression. I think it's rather common in hospitals.
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