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Rethinking the Diagnosis of Depression

Most people diagnosed with depression today aren’t depressed, according to Edward Shorter, a historian of psychiatry, in his latest book How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown

Specifically, about 1 in 5 Americans will receive a diagnosis of major depression in their lifetime. But Shorter believes that the term major depression doesn’t capture the symptoms most of these individuals have. “Nervous illness,” however, does.

“The nervous patients of yesteryear are the depressives of today,” he writes.

And these individuals aren’t particularly sad. Rather, their symptoms fall into these five domains, according to Shorter: nervous exhaustion; mild depression; mild anxiety; somatic symptoms, such as chronic pain or insomnia; and obsessive thinking.

5 Comments to
Rethinking the Diagnosis of Depression

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  1. I have experienced depression for most of my life and the symptoms have gone from more atypical with sadness to more typical with psychosis. Many individuals seem to have a combination of atypical and typical symptoms so I am not so sure this distinction is so helpful.

  2. This is an interesting article. As a therapist has worked in the field of addiction for the last ten years, half of which in dual diagnosis. The way in which I now tend to frame the majority of that work is that one is dealing with an anxiety condition. From my observations, the key underlying issue is the attenuation of unpleasant rising feelings of anxiety what ever the trigger is is relevant to the persons personal history. But as a term of description I frame the substance misuse as an attempt at self regulation…to reach emotional homeostasis. Calmness, free of anxiety. Often clients are signposted as depressed, or on initial appraisal, one might percieve them as depressed..i.e low mood. But I see this often transpires as a sequential accumulation of life issues which have never been able to be addressed (bereavement, abuse, low income, etc) that the client carries and copes as best they can with. They are drained, worried – anxious. But they are not depressed, in the classical manner that is defined as ‘melancholia’. A labile state which has more endogenous roots (?). These people function, use a mood altering substance to attenuate and do the best they can. ANti depressants do not tend to help these people although are often prescribed. I can think of only one client with whom an anti depressant had a significant outcome and she was morbidly suicidal. This was prior to my work with her, but she described prozac as having literally enabled her to live over nihis does not happen in these other cases and often these other cliets do not wnat to take these medications, somehow they know they are not right for them. But as practitioners we are somehow bound into this medicalised model of needing to uphold the necesity to maintain usage, even when it may not appear to be the most appropriate response. WHat Shorter is outlining here is a long overdue analysis of socio – psycho – biological approach which is necessary for properly integrated health care. It needs supported.

  3. I would thoroughly agree with this article and would like to add, that I now know two people who have been misdiagnosed as depressed,and have found out that the medication does not work because they actually have Ptsd. One of these people attempted suicide, and only after discovery that they in fact had ptsd and not depression, were they able to push for proper treatment, received cbt and are now much happier.

  4. As a person who has suffered (read:spent minutes/hours/days/weeks/months/years/decades/a lifetime in boomeranging pain – I don’t know why I am still alive – along with wonderful and rewarding adventures in my life only to find the pain returns on its own schedule) from depression. When my doctor called it severe depression I felt heard, maybe someone really believed me. So when does the pain stop? After the next therapy session? After a trip to the park with the dog? After a good night sleep or a hot bath or a bite of chocolate? Perhaps after all the pills are taken at once and you wait for the end and you sleep forever – no more pain. Who cares what the DSM V says. Just get rid of this relentless pain!

  5. Part of the problem is the fact we HAVE to have a specific diagnosis code to get paid. Depression is an easy one. There was a time you could put R/O but not anymore and you find something to stick



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