Er is veel mis met de vigerende criteria voor de diagnose ‘depressie’. Deze criteria werden in 1980 geïntroduceerd in de 3e editie van de ‘Diagnostic and statistical manual of mental disorders’ (DSM-III) en zijn sindsdien praktisch ongewijzigd gebleven.1,2 De criteria komen er in essentie op neer dat de patiënt bevraagd wordt over 9 depressieve symptomen, zoals somberheid, moeheid en veranderde eetlust. Aan de diagnose wordt voldaan wanneer 5 of meer van die symptomen, waaronder minimaal 1 kernsymptoom (sombere stemming of verlies van interesse of plezier), gedurende minstens 2 weken vrijwel elke dag aanwezig zijn en gepaard gaan met psychisch lijden of sociaal disfunctioneren. Er is geen wetenschappelijk bewijs dat deze DSM-criteria volstaan voor het vaststellen van een depressieve stoornis; de criteria waren louter gebaseerd op consensus onder psychiaters.3 De opstellers waren er echter heilig van overtuigd dat nader onderzoek de ‘stoornis’ die aan een ‘major depressive disorder’ ten…
Is de diagnose ‘depressie’ nog wel bruikbaar?
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The DSM diagnosis of depression is based solely on the presence of symptoms, without taking into account the context in which these symptoms have occurred. For this reason, the DSM diagnosis does not distinguish between sadness as a normal reaction to a painful loss and pathologically depressive reactions that are disproportionate to personal life events and circumstances. According to a group of mental health expert general practitioners, a true depressive disorder is characterized by a depression that has acquired a life of its own and is hard to control. This depression is severe, and is recognized by the patient as alien to his or her character. Loss of the ability to experience pleasure in ordinary things (anhedonia) and thoughts about death as an alternative for the torment experienced are often present. We recommend the diagnosis of depression be reserved for clearly pathologically depressive reactions that are also recognized as such by the patient.
Conflict of interest and financial support: a disclosure form provided by the author is available along with the full text of this article at www.ntvg.nl; search for A5684, click on ‘Belangenverstrengeling’ (‘Conflict of interest’).
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