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Do you know how psychiatrists or clinical psychologists diagnose depression? Have you read the DSM? Do you know how they come up with the criteria for psychiatr

by xijuan 14y ago

Do you know how psychiatrists or clinical psychologists diagnose depression? Have you read the DSM? Do you know how they come up with the criteria for psychiatric disorders in DSM? Do you know the controversies behind DSM? Do you know few decades ago homosexuality was regarded as a mental disorder? Do you know that there are researchers who want to introduce a new "psychiatric disorder" (i.e., hypersexual disorder) in the next edition of DSM for people who have sex more than 7 times a week ? Here is the criteria for major depression: Diagnostic criteria: Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day 1. Depressed mood most of the day. 2. Diminished interest or pleasure in all or most activities. 3. Significant unintentional weight loss or gain. 4. Insomnia or sleeping too much. 5. Agitation or psychomotor retardation noticed by others. 6. Fatigue or loss of energy. 7. Feelings of worthlessness or excessive guilt. 8. Diminished ability to think or concentrate, or indecisiveness. 9. Recurrent thoughts of death (APA, 2000, p. 356). I am sure everyone has met some of its criteria at some point in their life. Without a real diagnosis, you really can't say if the person has a major depression. Even with a diagnosis, how do you know the doctor is making the right diagnosis with SUCH VAGUE criteria? Edit: I am very aware of what DanBC has pointed out about the other criteria: i) at least 2 weeks ii) and at least five of the following symptoms iii) clinically significant impairment in social, work, or other important areas of functioning almost every day. BUT THEN, the question becomes "Why 2 week?" "Why at least five of the symptoms?" Who came up with the numbers? Let me tell you, the DSM committee have a lot of disagreement about those. Those numbers are not some magic numbers that once you pass that threshold, you suddenly become clinical depressed.

ErrantX 14y ago
I've always felt depression is only somewhat understood, as you say it's hard to diagnose. For example, #7 is a common one for me - and you simply can't see it or diagnose it unless I tell you. But you can usually tell from other things; like the fact I get obsessed with ideas and spend a lot of time walking (i.e. thinking/brooding). I agree with you; and I wasn't exactly trying to make a diagnosis over the internet. I was trying to point out that although Taren seems so certain he was not depressed, she makes some claims which are very much not the be-all-and-end-all of depression. And that some of the activities she describes are common tells for depression. My point being; it's not simple, and depression is a complex and evil thing.
DanBC 14y ago
> I am sure everyone has met some of its criteria at some point in their life It is incredibly frustrating that you say this, even while quoting the DSM which says: i) at least 2 weeks ii) and at least five of the following symptoms iii) clinically significant impairment in social, work, or other important areas of functioning almost every day. These symptoms are not vague. Unless you take one symptom, and ignore the significant impairment clause.
- lutusp 14y ago
  > These symptoms are not vague. Of course they are. And there's a lot of variability in diagnosis between practitioners. Some even say that depression isn't really a disease at all. There is an excellent book on this topic that I cannot recommend highly enough: Title: "Manufacturing Depression: The Secret History of a Modern Disease" Link: http://books.google.com/books?id=U-lvlVSGeEEC http://books.google.com/books?id=U-lvlVSGeEEC Quote: (about Congitive-behavioral therapy) “a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment.” Here's a discussion of the book (and topic) at the New Yorker entitled "Head Case": http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100...
lutusp 14y ago
> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depression as an illness with an unknown cause doesn't prevent psychiatry and clinical psychology from offering therapy and drugs of dubious efficacy. Antidepression drugs have been shown to be ineffective in most cases -- Link: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj... Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration" Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." The story is that drug companies publish only studies that support their belief in their drugs' efficacy. But when completed but unpublished studies are included, the evidence for the efficacy of antidepression drugs evaporates. The study's authors don't say the drug companies deliberately suppressed negative findings -- they leave that conclusion to the reader.
- darius42 14y ago
  I have many bad things to say about many antidepressant. E.g., they all have very annoying side effects, at least for me, and some of the side-effects (e.g., vivid dreams) require benzos to counter. And then benzo addiction is really no fun at all. Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even believe were real and not psychosomatic, until it later turned out that 25%-50% of all patients suffered these side effects, and the pharmaceutical company had neglected to inform anyone. On other other hand, Remeron surely saved my life. I have no doubt about this. I had been in the most miserable state you could ever possibly imagine and then some, and had been this way for months, and then within a day or two of starting Remeron, I was utterly fine. (Though ironically, it may have been another antidepressant that put me in this terrible state to begin with, as I had to go off it cold turkey due to it causing a different dangerous side effect.) As for diagnosing depression, it may certainly be the case that many cases are difficult to diagnose correctly. And there may be cases where there is no fact of the matter as to whether the particular symptoms count as depression. On the other hand, there are certainly cases where there is no question at all as to whether it's depression. I have been there quite a few times, and it's been as cut and dried as anything can be in this world.
thaumaturgy 14y ago
For what it's worth, I kinda agree with what I think you're getting at -- that the diagnosis for depression needs a lot of work and the DSM isn't infallible -- but your comment here is easy to interpret as a skepticism of the existence of depression, which might be why it's getting downvoted. Fortunately, there have been some recent advancements in neuroscience that can give us hope for improved diagnosis in the future (once the field is able to agree on what depression is, anyway).

by xijuan 14y ago

ErrantX 14y ago

I've always felt depression is only somewhat understood, as you say it's hard to diagnose. For example, #7 is a common one for me - and you simply can't see it or diagnose it unless I tell you. But you can usually tell from other things; like the fact I get obsessed with ideas and spend a lot of time walking (i.e. thinking/brooding). I agree with you; and I wasn't exactly trying to make a diagnosis over the internet. I was trying to point out that although Taren seems so certain he was not depressed, she makes some claims which are very much not the be-all-and-end-all of depression. And that some of the activities she describes are common tells for depression. My point being; it's not simple, and depression is a complex and evil thing.

DanBC 14y ago

> I am sure everyone has met some of its criteria at some point in their life It is incredibly frustrating that you say this, even while quoting the DSM which says: i) at least 2 weeks ii) and at least five of the following symptoms iii) clinically significant impairment in social, work, or other important areas of functioning almost every day. These symptoms are not vague. Unless you take one symptom, and ignore the significant impairment clause.

lutusp 14y ago
> These symptoms are not vague. Of course they are. And there's a lot of variability in diagnosis between practitioners. Some even say that depression isn't really a disease at all. There is an excellent book on this topic that I cannot recommend highly enough: Title: "Manufacturing Depression: The Secret History of a Modern Disease" Link: http://books.google.com/books?id=U-lvlVSGeEEC http://books.google.com/books?id=U-lvlVSGeEEC Quote: (about Congitive-behavioral therapy) “a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment.” Here's a discussion of the book (and topic) at the New Yorker entitled "Head Case": http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100...

lutusp 14y ago

> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depression as an illness with an unknown cause doesn't prevent psychiatry and clinical psychology from offering therapy and drugs of dubious efficacy. Antidepression drugs have been shown to be ineffective in most cases -- Link: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj... Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration" Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." The story is that drug companies publish only studies that support their belief in their drugs' efficacy. But when completed but unpublished studies are included, the evidence for the efficacy of antidepression drugs evaporates. The study's authors don't say the drug companies deliberately suppressed negative findings -- they leave that conclusion to the reader.

darius42 14y ago
I have many bad things to say about many antidepressant. E.g., they all have very annoying side effects, at least for me, and some of the side-effects (e.g., vivid dreams) require benzos to counter. And then benzo addiction is really no fun at all. Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even believe were real and not psychosomatic, until it later turned out that 25%-50% of all patients suffered these side effects, and the pharmaceutical company had neglected to inform anyone. On other other hand, Remeron surely saved my life. I have no doubt about this. I had been in the most miserable state you could ever possibly imagine and then some, and had been this way for months, and then within a day or two of starting Remeron, I was utterly fine. (Though ironically, it may have been another antidepressant that put me in this terrible state to begin with, as I had to go off it cold turkey due to it causing a different dangerous side effect.) As for diagnosing depression, it may certainly be the case that many cases are difficult to diagnose correctly. And there may be cases where there is no fact of the matter as to whether the particular symptoms count as depression. On the other hand, there are certainly cases where there is no question at all as to whether it's depression. I have been there quite a few times, and it's been as cut and dried as anything can be in this world.

thaumaturgy 14y ago

For what it's worth, I kinda agree with what I think you're getting at -- that the diagnosis for depression needs a lot of work and the DSM isn't infallible -- but your comment here is easy to interpret as a skepticism of the existence of depression, which might be why it's getting downvoted. Fortunately, there have been some recent advancements in neuroscience that can give us hope for improved diagnosis in the future (once the field is able to agree on what depression is, anyway).