Advances in Psychiatric Treatment (2009) 15: 279-285. doi: 10.1192/apt.bp.108.005827
© 2009 The Royal College of Psychiatrists
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Major depression: revisiting the concept and diagnosis

K. S. Jacob

K. S. Jacob completed his medical (MBBS) and doctoral training in psychiatry (MD) at the Christian Medical College, Vellore, India. He also trained at the Institute of Psychiatry, London, where he obtained the Doctor of Philosophy (PhD) in epidemiology. He is currently Professor and Head of the Department of Psychiatry at the Christian Medical College, Vellore.

Correspondence: Correspondence Dr K.S. Jacob, Professor of Psychiatry, Christian Medical College, Vellore 632002, India. Email: ksjacob{at}cmcvellore.ac.in

The classification of depression has been debated for decades. The introduction of operational criteria and the category of major depression were significant advances in the 1970s. However, the validity of the major depression category is controversial. The article highlights the limitations of using severity criteria and cross-sectional evaluation to diagnose depression. It recommends the classic typologies (melancholia, dysthymia and adjustment disorder) for clinical presentations of depression, highlighting the need to use longitudinal clinical patterns and context for diagnosis. Major depression owes its success to its loose definition, to the subordinate status of adjustment disorders and dysthymia and to the mechanistic application of the diagnostic hierarchy and criteria. There is a need to focus more on the context of depression (stress, coping and support) and to reduce the medicalisation of distress.


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