Mario Maj on classifying depression

Mario Maj is a psychiatrist who was part of the mood work group for the DSM 5. He gave a lecture on the nosology of depression at the annual meeting of the RCPsych general adult faculty. He described 3 approaches to the diagnosis of depression:

1. The contextual approach, for example the distinciton between what may be called endogenous and reactive depression. The arguments against such a distinction are that depression leads to the induction of negative life event recall and that classification is therefore difficult as endogenous depression may be diagnosed as reactive due to apparent recall. He also noted that only 4-5% of depressive episodes under the current diagnostic system are considered "untriggered".

2. The quantitative approach, here he brought to our attention the criticism of the present diagnostic system in that they may be oversimplified as there is not measure of the severity of individual categories that make up the syndrome.

 3. The pragmatic approach, where depression is considered as a dimensional construct and the problem becomes where to draw the categorical bounds of clinical diagnosis, for example should this be number of symptoms, severity of symptoms or a combination. He considered the importance of considering tretment oucomes when designating diagnostic categories, mentioning the classic Paykel study from 1988 that showed clinical outcomes with amitryptiline only improve in moderate and severe depressive episodes.

BMJ 2013, 9 Feb, vol 346:f174 Report of a public health intervention in Massachusets that reported on the change in overdose deaths following the introduciton of overdose education and nasal naloxone distribution (OEND) using interrrupted time series analysis.

BMJ 2013, 9 Feb, vol 346:f288 Cross-sectional pharmacovigilance study of antidepressant effect on QTc in secondary care patients. Effects for QTc prolongation found for citalopram, escitalopram and amitryptiline. Also clear effect for methadone at low doses.

This is starting as a blog on all things to do with psychiatry and associated disciplines. I hope to answer some of the questions I have and some that other people pose. Perhaps over time a useful resource will build up.