{"id":31492,"date":"2012-12-31T15:09:12","date_gmt":"2012-12-31T20:09:12","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=31492"},"modified":"2012-12-31T19:02:37","modified_gmt":"2013-01-01T00:02:37","slug":"the-what-is-absurd","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/12\/31\/the-what-is-absurd\/","title":{"rendered":"the what<\/em> is absurd…"},"content":{"rendered":"\n
In case it’s not apparent, I’m trying to get my remaining thoughts about the DSM-5 said, so as to put it away and move on in the New Year. I’ll think I’m done with it, then I’ll read something like the recent Washington Post article<\/a>, and it gets me all stirred up again [see Howard Brody’s comments<\/a>]. In my post<\/a> about that article, I looked at an article by Zisook et al<\/a>, a small uncontrolled trial of Wellbutrin in bereavement. And the WaPo article mentioned Zisook’s involvement with the DSM-5 Task Force:<\/div>\n
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A key adviser to the committee — he wrote the scientific justification for the change — was the lead author of the 2001 study on Wellbutrin, sponsored by GlaxoWellcome, showing that its antidepressant Wellbutrin could be used to treat bereavement…<\/strong><\/sup><\/div>\n<\/blockquote>\n
So I looked up Zisook’s articles<\/a> on grief and found 37 papers spanning over thirty years, focusing on the Bereavement Exclusion since 2007. Something seemed odd about that, and stuck with me. Then I remembered what it was. The formal rationale for dropping the Bereavement Exclusion from the Major Depressive Disorder posted on the DSM-5 website wasn’t written by Dr. Zisook, it was written by Kenneth S. Kendler, M.D.: Member, DSM-5 Mood Disorder Work Group<\/a>. The logic of Kendler’s explanation gave me a headache when I read it a year ago [depressing ergo<\/em>-mania…<\/a>]. Then I noticed the obvious, that Drs. Zisook and Kendler were co-authors on many of those articles. This was all beginning to feel like a campaign:<\/div>\n
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Validity of the bereavement exclusion criterion for the diagnosis of major depressive episode<\/a>
by SIDNEY ZISOOK, KATHERINE SHEAR, and KENNETH S KENDLER<\/sup>
World Psychiatry<\/font><\/strong>. 2007 6[2]: 102–107.
[full text on-line]<\/div>\n

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Since the publication of DSM-III in 1980, the official position of American psychiatry has been that the presence of bereavement is an exclusion criterion for the diagnosis of a major depressive episode (MDE). However, the empirical validity of this exclusion has not been well established. As DSM-V is now being planned, it is timely to reexamine the bereavement exclusion, particularly in the light of new evidence since the last reviews of this subject. This paper evaluates the relative validity of two competing hypotheses: 1) the bereavement exclusion for the diagnosis of MDE is not valid because, using validating criteria, bereavement related depression (BRD) within the first two months after the death of a loved one resembles non-bereavement related depression (SMD); 2) the bereavement exclusion for the diagnosis of MDD is valid because, using validating criteria, BRD within the first two months after the death of a loved one does not resemble SMD. The prevailing evidence more strongly supports Hypothesis 1 than Hypothesis 2. Thus, the bereavement exclusion for the diagnosis of MDE may no longer be justified.<\/strong><\/sup><\/div>\n<\/blockquote>\n
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Does Bereavement-Related Major Depression Differ From Major Depression Associated With Other Stressful Life Events?<\/a>
by Kenneth S. Kendler; John Myers; and Sidney Zisook<\/sup>
American Journal of Psychiatry<\/font><\/strong>. 2008 165:1449-1455.
[full text on-line]<\/div>\n

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Objective<\/font><\/u>: Of the stressful life events influencing risk for major depression, DSM-III and DSM-IV assign a special status to bereavement. A depressive episode that is bereavement-related and has clinical features and course characteristic of normal grief is not diagnosed as major depression. This study evaluates the empirical validity of this exclusion criterion. <\/strong><\/sup><\/div>\n
Method<\/font><\/u>: To determine the similarities of bereavement-related depression and depression related to other stressful life events, the authors identified and compared cases on a range of validators in a large-population-based sample of twins. The authors evaluated whether cases of bereavement-related depression that also met DSM criteria for “normal grief” were qualitatively distinct from other depressive cases.<\/strong><\/sup><\/div>\n
Results<\/font><\/u>: Eighty-two individuals with confirmed bereavement-related depression and 224 with confirmed depression related to other stressful life events were identified. The two groups did not differ in age at onset of major depression, number of prior episodes, duration of index episode, number of endorsed “A criteria,” risk for future episodes, pattern of comorbidity, levels of extraversion, risk for major depression in their co-twin, or the proportion meeting criteria for “normal grief.” However, individuals with bereavement-related depression were slightly older, and more likely to be female, and had lower levels of neuroticism, treatment-seeking, and guilt and higher levels of fatigue and loss of interest. Interaction analyses failed to find unique features of people whose illness met criteria for both bereavement-related depression and normal grief compared to those whose illness was related to other life stressors.<\/strong><\/sup><\/div>\n
Conclusions<\/font><\/u>: The similarities between bereavement-related depression and depression related to other stressful life events substantially outweigh their differences. These results question the validity of the bereavement exclusion for the diagnosis of major depression.<\/strong><\/sup><\/div>\n<\/blockquote>\n