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Re: Brain Signature for Melancholia Identified » ed_uk2010

Posted by Robert_Burton_1621 on February 23, 2015, at 10:29:07

In reply to Re: Brain Signature for Melancholia Identified » Robert_Burton_1621, posted by ed_uk2010 on February 22, 2015, at 16:30:01

>It is important to bear in mind, however, that depression with melancholic features is not necessarily more severe than non-melancholic depression. Melancholic depression is not synonymous with severe depression.... Although melancholic depression is usually severe, other forms of depression can be equally severe in a different way. As an example, the mood changes seen in some forms of 'atypical' depression may result in people feeling OK briefly and then intensely suicidally depressed later. This type of illness can be very serious.
>

Very good points; I entirely agree.

One of the purposes of defining depression by reference to identifiable types (to the extent that they are distinct and identifiable) is to counter the dominant paradigm according to which "depression" is a unitary clinical entity which differs only in respect of the extent of the severity with which it is experienced. When you think about it, this is a very odd way of thinking about disease. While psychiatry, because of its need to grapple with the subjective/phenomenological in addition to the neuro-organic and biochemical, raises complexities in nosology which are more and different than those faced by other specialties, I am not sure this rationally justifies psychiatry's quite unique approach to classifying the disorders, especially the depressive disorders, within its purview. An oncologist does not diagnose a particular type of cancer by reference *primarily* to its severity; rather, severity is a potential property of some types of cancer, whose nature is classified by reference to traits biologically internal to, and often distinctive of, that type. The DSM, however, takes severity as a primary diagnostic indicator, and posits a scale along which an essentially unitary disorder of "depression" is then plotted according to patient symptoms.

This is one reason why I think the recent research to which I pointed is so important.

One consequence of the DSM criteria is that a person who suffers chronic depression after a severe "melancholic" or MDD episode (i.e., whose "depression" has never resolved), is often diagnosed as suffering from "dysthymia" simply by virtue of the fact that his or her chronicity is not as severely experienced as that index episode.

This diagnostic choice can then have an immediate and direct influence on recommended treatments.

In regards to atypicality, my understanding is that it would fall on the side of the biological or autonomous depressions, along with psychotic depression and melancholia. The depressive phase of bi-polar disorder is, from my understanding, usually melancholic, though as SLS has hypothesised, its characteristic traits may indicate that it amounts to a hybrid type.


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