DSM 5 proposes change to major depressive order

Discussion in 'The Watercooler' started by TerryJ2, Aug 14, 2010.

  1. TerryJ2

    TerryJ2 Well-Known Member

  2. Jena

    Jena New Member

    thanks for sharing that.
  3. KTMom91

    KTMom91 Well-Known Member

    Wow...I agree with the author as well. This could really cause some serious problems for people.
  4. JJJ

    JJJ Active Member

    The DSM5 committee seems to be overreaching on a lot of their changes.
  5. gcvmom

    gcvmom Here we go again!

    Oy. That is reaching a bit!
  6. Marguerite

    Marguerite Active Member

    The problem here is that the article author (and us) are looking at depression from a very broad point of view including the social aspects of all forms of it, while the authors of the DSM criteria are looking at depression purely from a medical point of view. And medically, it is correct to include ALL forms of depression, including natural processes of grieving. They are medically indistinguishable by all measures currently in use. However, the author of this article is also correct - once we medicalise normal processes, we risk sidetracking these processes and sending messages that it is unhealthy to grieve, wrong to feel sad at times. On the flip side, we also risk devaluing the need for intervention in people who have serious clinical depression.

    It is important to categorise the depression and to also allow a certain amount of it as understandable and appropriate in certain circumstances. The trouble is - where do you draw the dividing line?

    I remember reading up on some research results, must have been 15 years ago now. The research was on brain waves and depression; they were trying to find some unique brain wave pattern distinctive in depression. They were fairly sure they had found it. They would hook patients up to the EEG and record brain waves, while interviewing the subject and asking them a series of questions (the same questions for all subjects). They had controls as well as people diagnosed with clinical depression. The interesting discovery (written up in the journal I was reading) came when one of the controls, who happened to be another researcher from the lab next door helping out for the sake of numbers, was still hooked up while they were taking a break from the process. He did not have depression and his brain waves indicated this. Then the researcher, in conversation, asked his control subject about his family. The control subject told him that his wife (or mother, or dog - I can't recall) had recently died, and while he talked about his very recent and raw grief, the brain waves changed drastically, and were indistinguishable to those found in patients with clinical depression. However, as he talked, the mood lifted after about fifteen minutes and the brain waves returned to normal.

    The thing is - it was the sadness he felt while sharing his sad news, that produced the classic depression brainwave pattern. They went on to study this further and found this happens in everybody - when we feel sad about something, it resembles depression. The difference between this and clinical depression then becomes a matter of duration.

    I remember attending a seminar on depression (about 1989) in which the distinction was made between clinical depression (aka endogenous depression - depression from within) and reactive depression, which I call depression for a known reason. We were told that someone with clinical depression is someone who cannot identify a cause; the emotion simply arrives like a raincloud. Reactive depression - you can generally define it as, "I feel sad because I lost my job," or some other stated reason.
    But the presentation can be very similar. Also, if the emotion is preventing you from functioning, then you may need professional help in dealing with it.

    I've experienced clinical depression as well as reactive depression. In my case, much of the clinical depression was actually caused by antidepressant medication which I had been put on to try to manage chronic pain. The depression would simply arrive, I would feel it sliding in and when I mentally went digging to find out why I felt sad, I couldn't identify a reason. I explored all possible options and my brain did not go "aha!" at any time. So I found the best way to handle this was distraction. Get busy, and distract myself until the bad feeling went away. But in someone who is too overwhelmed with this feeling, medication (or some other intervention) could well be needed.

    Reactive depression - I could identify why. My mind would pounce on the cause and worry at it like a dog with a bone. "I'm depressed because I'm fed up with my chronic pain." Or "I'm depressed because it's raining when I had planned to go to the beach." I found I coped best with reactive depression, by actively focussing on why I was depressed, so I could begin to find a solution. Finding a solution eased the source of the depression which in turn eased my mood.Two different kinds of depression which initially feel the same, but had two totally opposite coping methods.

    When I had the PSD, I was initially diagnosed with post-natal depression. But I wasn't depressed. I was angry. Furious. I felt I had been neglected, my pain ignored, my concerns dismissed. And it was fed and amplified by all the times in the past when the same sort of thing had happened. It became cumulative and so jumbled, that at first I couldn't identify the emotion or the reasons. It was beginning to feel like endogenous depression, except when I really felt for it mentally, I couldn't find the depression. I was crying a lot, but it was fear and anger. There was also a lot of grief in there too, jumbled with the anger. It needed professional help to find my way through the maze, doctors wanted to put me on medication. If I could tolerate the stuff it would have helped, even though my emotions were logical, natural, explainable and justified. But with professional help as well as some very useful help from friends as well as my own efforts, I began to find my way out of the maze. No medication.

    So while I can see the concerns for the changes to the DSM criteria, it is working to include people who may be 'merely' grieving. It stops these people being disenfranchised. Because sometimes they need help too.

    It will be a wonderful thing, when depression loses its stigma and gets the appropriate help. When that happens, we are less likely to medicalise what is normal and being managed.

    When I was assessed by a psychiatrist specifically for depression (long before the PTSD) the summary was, "You have had some depression in the past, due to developing chronic disability and having to change career path. It was reactive depression and you dealt with it yourself. You do not currently have depression but it could return. If it does, call me. Until then, you don't need me."

    I'm curious as to who the authors of the new DSM V are. I suspect I might know one of them. He's an Aussie researcher who specialises in depression (it was his talk I attended in 1989) and who has done a lot of work with CDC.

  7. klmno

    klmno Active Member

    in my humble opinion, tdocs and those in authority of MH profs just aren't what they used to be. It really seems to have turned into a field that almost anyone can get into (and does) expecting to get treated like other licensed profs yet not having half the accountability or responsibility as any other licensed prof as required by their board or authority. I have no pity on them at all for not getting paid more. The ones who are really good are specialized and usually picked pretty quickly to be in places like children's hospitals, VA, etc, and they get paid very well and I have no problem with that. But the majority of the prof isn;t worth their salt- they are the ones acting like trained Pavlow's dogs trying to push an agenda. Maybe the people listing criteria for the dsm diagnosis's feel like if they don't spell out depressive signs, tdocs won't even notice them. OK, I'm saying that mean-spirited. I don't agree with going that far with the diagnosis either. They should stop and think sometimes about the repurcussions of throwing out a diagnosis for every little thing.
  8. Marguerite

    Marguerite Active Member

    I'm not sure how the mental health profession is in the US, but in Australia is has tightened up a great deal. There are clear distinctions between psychologists (of varying kinds, all carefully defined and regulated) and psychiatrists, who first of all have to also be qualified and registered doctors. Ideas and attitudes have changed considerably and a lot of dead wood has been cleaned out of the professional ranks.

    I do agree we have too many differential diagnoses, for what often turns out to be merely a symptom of another disorder, not a specific disorder standing alone. How many of us have seen the "alphabet soup" list of diagnoses, of new members here? Or in our own kids? The problem isn't with the DSM criteria, though, it is with the medical profession as a whole being fragmented and not treating patients holistically. Yes, different conditions and sub-conditions are increasingly defined in detail. But they are also often connected to other 'umbrella' conditions and doctors using DSM criteria need to know what they're doing and look broadly, rather than in fine minute detail.

    The problem rests with medical practitioners who get lazy and use the DSM as a "paint by numbers" tool, instead of also engaging their brains. More vigilance in the medical profession, as well as double-checking, will weed out such mistakes. But only if we as consumers also stop demanding labels where they're not always appropriate.

  9. klmno

    klmno Active Member

    I agree whole-heartedly. Here in the US, or at least this state, I can look online for any complaints (formal) or sanctions taken against a licensed professional. In any profession I look up (attnys, engineers, etc), I find a fraction have misrepresented themselves, took money without providing the service they were paid for, practiced outside the area of competency, etc. and that can probably be expected- there are a few bad fish in any group. If I look up a NH prof, the ONLY thing I have ever seen listed is "had inappropriate relationship with patient", What that tells me is that there is no accountability for them saying they can treat a diagnosis when they really have no clue how to or anything else. I'm sure it wouldn't be easy for their board of authority to monitor and gage these things, but their board should be at least making an effort to weed out the incompetent ones. I realize a MH prof has no business going to bed with a client but frankly, as long as they don't touch a kid I am a lot more concerned about whether or not they can diagnosis and whether or not they can give appropriate therapy/treatment for a problem. I will say that my frustration is not with psychiatrists, who do have the MD. But here, our psychs and tdocs are "monitored" by a different board than MDs. Our psychiatrists are more likely to use their brain though and putn more weight on their training, experience, and common sense. Our other MH profs are liked trained monkeys in many cases- and put too much bias into it. For instance, they read the list of criteria for a diagnosis and if a kid fits two things and the person has heard from anyone that this is what the kid has, they automatically give that diagnosis- never mind that the list also includes things like "ongoing for 6 months or more"- they apparently overlook that part. And they don't look at the whole picture to find which diagnosis fits best.

    I don't want to hi-jack T's thread, I just have a big problem with this typical approach in therapy these days- obviously it isn't working very well and I'm tired of incompetent tdocs saying the problem is the client or the client's parents not trying hard enough- or it must be the medication. Yeah right- well after trying what seems like 50, I don't think they have the solution.