{"id":54146,"date":"2015-02-09T00:01:12","date_gmt":"2015-02-09T05:01:12","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=54146"},"modified":"2015-02-09T03:31:07","modified_gmt":"2015-02-09T08:31:07","slug":"political-sabbatical","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/02\/09\/political-sabbatical\/","title":{"rendered":"political sabbatical…"},"content":{"rendered":"
My first thumbing through the DSM-III in 1980 landed me in Major Depressive Disorder [MDD], and it’s where I’ve remained. I’ve written about it enough here to thoroughly earn my 1boring<\/font><\/em>oldman moniker [see a mistake…<\/a>, further thoughts on the mistake…<\/a>, and yet another mistake…<\/a> for just one version]. In their zeal to bring psychiatric classification more into the medical realm, they eliminated the most medical of all psychiatric diagnoses – Melancholic Depression. As I’ve said before here often, in a former time the word depression<\/font><\/strong><\/em> had different connotations than it does today. It referred to a felt emotion, something all of us are capable of feeling – a biological given. A major clinical distinction was d<\/u>epression, the emotion, and D<\/u>epression, the illness known clinically as Melancholic Depression, which is both experienced and observed as something very different from d<\/u>epression [see melancholia…<\/a>]. Several years back, Dr. Bernard Carroll<\/font> put Melancholia<\/font> to verse [right][see Bringing Back Melancholia<\/a>]. On the road to the DSM-5, a Who’s Who from the ranks of psychiatry lobbied in vain to have this diagnosis returned to the official classification [Note: That list of authors included Dr. Robert Spitzer<\/font> himself, who was the person who had eliminated it some thirty years before].<\/div>\n
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Issues for DSM-5: Whither Melancholia? The Case for Its Classification as a Distinct Mood Disorder<\/a><\/div>\n
by Gordon Parker, M.D.<\/font><\/strong>; Max Fink, M.D.; Edward Shorter, Ph.D.; Michael Alan Taylor, M.D.; Hagop Akiskal, M.D.; German Berrios, M.D.; Tom Bolwig, M.D.; Walter A. Brown, M.D.; Bernard Carroll, M.B.B.S.; David Healy, M.D.; Donald F. Klein, M.D.; Athanasios Koukopoulos, M.D.; Robert Michels, M.D.; Joel Paris, M.D.; Robert T. Rubin, M.D.; Robert Spitzer, M.D.<\/font><\/strong>; and Conrad Swartz, M.D.<\/div>\n
American Journal of Psychiatry<\/font><\/strong> 2010 167:745-747.<\/div>\n
[full text on-line]<\/a><\/div>\n

<\/p>\n

Melancholia, a syndrome with a long history and distinctly specific psychopathological features, is inadequately differentiated from major depression by the DSM-IV specifier. It is neglected in clinical assessment [e.g., in STAR*D] and treatment selection [e.g., in the Texas Medication Algorithm Project]. Nevertheless, it possesses a distinctive biological homogeneity in clinical experience and laboratory test markers, and it is differentially responsive to specific treatment interventions. It therefore deserves recognition as a separate identifiable mood disorder.<\/div>\n
<\/div>\n
Melancholia is a lifetime diagnosis, typically with recurrent episodes. Within the present classification it is frequently seen in severely ill patients with major depression and with bipolar disorder. Melancholia’s features cluster with greater consistency than the broad heterogeneity of the disorders and conditions included in major depression and bipolar disorder. The melancholia diagnosis has superior predictive validity for prognosis and treatment, and it represents a more homogeneous category for research study. We therefore advocate that melancholia be positioned as a distinct, identifiable and specifically treatable affective syndrome in the DSM-5 classification.<\/div>\n<\/blockquote>\n
I recently read a remarkable paper by the lead author above, Dr. Gordon Parker<\/font> of The Black Dog Institute in New South Wales Australia, that came at this distinction in a unique way:<\/div>\n
\n
Cleaving depressive diseases from depressive disorders and non-clinical states<\/a><\/div>\n
by Parker G, Paterson A, and Hadzi-Pavlovic D.<\/div>\n
Acta Psychiatrica Scandanavia<\/font><\/strong> 2015 Jan 6. [Epub ahead of print] <\/div>\n

<\/p>\n

OBJECTIVE<\/font><\/strong><\/u>: We sought to determine whether putative depressive diseases could be differentiated categorically from clinical depressive disorders and non-clinical mood states.<\/div>\n
METHOD<\/font><\/strong><\/u>: We interviewed volunteers who reported or denied any lifetime depressive mood state and analyzed data from the former group reporting on their ‘most severe’ depressive episode. We employed latent class analysis [LCA] to determine whether a two-class solution was supported and the contribution of individual variables to class allocations.<\/div>\n
RESULTS<\/font><\/strong><\/u>: All variables were significant predictors of class allocation. LCA-assigned Class I participants reported more depressive symptoms, had more distressing episodes and more lasting consequences, were more likely to view their depression as ‘like a disease’, and as being both disproportionately more severe and persistent in relation to any antecedent stressor. Validation involved comparison of LCA assignment with DSM-IV diagnosis for their most severe depressive episode. Of those assigned to Class I, 89% had a DSM diagnosis of melancholic, psychotic or bipolar depression. Class II had all those failing to meet criteria for a depressive episode and the majority of those with a non-melancholic depressive condition.<\/div>\n
CONCLUSION<\/font><\/strong><\/u>: Despite not including individual depressive symptoms<\/font><\/strong>, study variables strongly differentiated putative depressive diseases from a composite of clinical depressive conditions and subclinical depressive states.<\/div>\n<\/blockquote>\n
The point here is that those unique symptoms we’ve always seen as defining Melancholia moved with this study from prose and poetry to an objective instrument. And complex cluster analysis of the results of that instrument in a mixed cohort of subjects with and without a previous depressive episode dramatically separated them into two relatively homogeneous groups – melancholic<\/em> versus something else<\/em>. Further, cross checking those clusters with conventional diagnostic criteria [DSM-IV] was a surprisingly good fit. I hope this paper becomes freely available; gets presented in more detail elsewhere; and is scheduled for replication trials forthwith. So far, Melancholic depression separates from the other depressions as a unique entity as cleanly as one could hope from the technology available for such an analysis. Melancholia is a thing of its own just like it has always been<\/em> – not a feature of something else which never was<\/em>. Maybe we can now pick up this thread that went on political sabbatical in 1980, and figure out what Melancholia is after all…<\/div>\n","protected":false},"excerpt":{"rendered":"

My first thumbing through the DSM-III in 1980 landed me in Major Depressive Disorder [MDD], and it’s where I’ve remained. I’ve written about it enough here to thoroughly earn my 1boringoldman moniker [see a mistake…, further thoughts on the mistake…, and yet another mistake… for just one version]. In their zeal to bring psychiatric classification […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-54146","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=54146"}],"version-history":[{"count":37,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54146\/revisions"}],"predecessor-version":[{"id":54184,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54146\/revisions\/54184"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=54146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=54146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=54146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}