Electronic Letters to:

EDITORIALS:
James Cole, Peter McGuffin, and Anne E. Farmer
The classification of depression: are we still confused?
The British Journal of Psychiatry 2008; 192: 83-85 [Abstract] [Full text] [PDF]
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[Read eLetter] Classification of Depression: Authors' hubris.
Max Fink   (17 March 2008)

Classification of Depression: Authors' hubris. 17 March 2008
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Max Fink,
Professor of Psychiatry & Neurology
Stony Brook University

Send letter to journal:
Re: Classification of Depression: Authors' hubris.

max.fink{at}sunysb.edu Max Fink

Cole, Guffin, and Farmer dismiss the re-formulation of Melancholia as a defined subtype of major mood disorder as another form of severe major depressive disorder. The present criteria for major depression and bipolar disorder allow heterogeneous populations of all manner of severity, with unknown etiologies or pathophysiologies to be included in samples. Such classifications have led to the failed medication trials of STAR*D, TMAP, STEP-BD, and the present PLoS analysis of SSRI drug effects.

Within the large population of major depression is a population of severely depressed, often psychotic and suicidal, who are identified by abnormalities in cortisol metabolism and severe vegetative abnormalities. The measurable cortisol abnormality normalizes with adequate treatment, and returns during relapse. Melancholia so defined does not respond to psychotherapy and poorly to SSRI. The patients require more effective antidepressant treatments, essentially TCA and ECT.

The epidemiological findings reflect the failure of the present DSM criteria for 'melancholic subtype" to define the patients identified as meeting criteria for Melancholia.

The authors' efforts in genetic studies have failed to identify a genetic relationship in a psychiatric illness. Their efforts would be enhanced were they to examine the Melancholia concept instead of denigrating it.