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(PSYCHIATRIC TIMES) - Major depressive disorder (MDD) has become psychiatry’s signature diagnosis. Depression is diagnosed in about 40% of patients who see a psychiatrist. This percentage is double that of just 20 years ago, and it is far higher than that of any other diagnosis. The World Health Organization (WHO) estimates that worldwide depression is the leading cause of disability for people in midlife and for women of all ages.

Consumption of antidepressants has soared since 1990. Roughly 10% of women and 4% of men in the United States take antidepressant medication at any time. By 2000, antidepressants were the best-selling prescription drugs of any type. Yet epidemiological studies suggest that there are still vast numbers of untreated depressed individuals. Consequently, primary care practitioners have been recruited as the first line of defense, and many now routinely screen patients for depression. To catch the problem early, a presidential commission has recommended that every adolescent in the country should be screened for depression by the time he or she reaches age 18. Screening is proceeding in some schools.

What accounts for this seeming epidemic of depression? Although depression has been part of the psychiatric canon since the earliest writing of the ancient Greeks, depression was a relatively insignificant diagnosis just 50 years ago. In our recent book, The Loss of Sadness: How Psychiatry Transformed Normal Misery Into Depressive Disorder (Oxford University Press), we argue that the recent pandemic of seeming depressive disorder is the result of changes in the psychiatric diagnostic system presented in DSM-III in 1980 and that persist to the present.

In many respects, DSM-III (and subsequent versions) has been one of psychiatry’s greatest accomplishments. It was the first to use observable symptoms, rather than unobservable (and undemonstrated) etiological processes, to define the various types of mental disorders. Its clear definitions of discrete categories of disorder enhanced diagnostic reliability, thus putting to rest antipsychiatric arguments about the spuriousness of psychiatric diagnosis. These definitions allowed psychiatrists to communicate in a common theory-neutral language, irrespective of theoretical perspectives, that improved the cumulativeness of research.

Yet, these undoubted achievements also entailed some important disadvantages. These drawbacks have become especially apparent in the definition of MDD, and have had substantial social consequences.

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