New Classification For Subtypes Of Depression Proposed

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In the current issue of Psychotherapy and Psychosomatics, a new classification of depression subtypes has been put forward by Lichtenberg and Belmaker.

They argue that a simple diagnosis of a major depressive disorder (MDD) is no longer enough to guide treatment and it’s true, many people diagnosed with a major depressive disorder do not respond to standard anti-depressant medication, perhaps because specific needs aren’t being catered for.

At the moment the DSM-1V allows for ‘bereavement’ exclusion but, as the paper says, it may be that other life events need to be taken into consideration such as childhood trauma, stress in the marriage or at work, and also medical health, but at the moment the official criteria for diagnosing depression doesn’t specifically refer to subtypes of major depression that may require specific treatment.

The report says that previous attempts to describe different types of depression simply by analysing the symptoms of large numbers of people suffering from depression without taking into consideration these sorts of life events haven’t been successful and yet there is evidence that the effects of these life events is strong and bereavement is no different from other stresses associated with depression.

In their paper, the authors propose an intuition based proposal for classifying depression which is not an evidence-based replacement of the current DSM-IV for Major Depressive Disorder.

They propose the following depression subtypes:

  • Type A: Depression with Anxiety
  • Type B: Acute Depression
  • Type C: Adult Depression after Childhood Trauma
  • Type D: Depressive Reaction to Separation Stress
  • Type E: Postpartum Depression
  • Type F: Late-Life Depression
  • Type G: Psychotic Depression
  • Type H : Atypical Depression
  • Type I : Bipolar Depression
  • Type J : Depression Secondary to Substance Abuse or to a Medical Condition

According to the authors, Adult Depression after Childhood Trauma may be a unique form of depression where early suffering causes lasting neurobiological changes which make these individual vulnerable to stress throughout their lives.

Depression is still not fully understood and although it is treatable, it could be that a better classification system would enable better treatment options.

The authors reckon that it’s time for a change and a subtyping of depression could lead to identification of different subtypes that would be more responsive to drug treatment and separate out the subtypes that do not really respond to current antidepressant drugs.

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