Depressive Disorders

Depressive Disorders

Depressive Disorders

Depressive Disorders


From Chapter 1 "Depression, like many other mental disorders, is characterised by the presence of a number of symptoms which are changeable over time." Among these symptoms are a depressed mood and a loss of interest; physical and cognitive changes may also occur. Because of difficulties in diagnosis (and varied criteria) only estimates in the global number of cases of depression can be made. Some estimates put it in front of chronic heart disease as a health problem and cause of death.

This revised edition covers developments in diagnosis, theraphy, prognosis, economic evaluation and quality improvement.

• Provides accompanying commentaries by an outstanding line up of contributors

• Covers developments in diagnosis, therapy, prognosis, economic evaluation and quality improvement

• Provides an unbiased and reliable reference point


Among the most serious difficulties that beset the field of psychiatry are the stigma marking mental illness and all that is connected with it (from its treatments and institutions to mental health workers and families of people with mental illness), disunity within the profession, and the gaps between findings of research and practice. These three sets of problems are interconnected: the disregard of research findings contributes to the persistence of differences in the orientation of psychiatric schools, and this diminishes the profession's capacity to speak out with one voice and to demonstrate that most mental illnesses can be successfully treated and are not substantially different from other diseases.

The diagnosis and treatment of depressive disorders illustrate the gaps that exist between research evidence, clinical experience, and guidelines for practice and quality assurance. Although clinicians, for example, feel that there are significant difficulties in the application of research criteria to the diagnosis of depression in people who suffer from a severe physical illness, current classifications of mental disorders contain no provisions that would make them easier to apply in such instances. Psychodynamic psychotherapies, the efficacy of which is not supported by empirical evidence, are still widely used in many countries, whereas other forms of psychotherapy, for which research evidence of effectiveness is available, remain unknown or scarcely used. Many clinicians continue to believe that there are significant differences in the effectiveness of antidepressant drugs, although research tends to demonstrate that they are equivalent, and some claim that tricyclic antidepressants are active when given in doses that are below the range that research has proved to be effective.

Differences of opinion between skilled clinicians and discussions about reasons for the gaps between research findings and practice are not reflected in the current psychiatric literature. the experience of skilled clinicians is only rarely published in psychiatric journals, while the best of scientific evidence is only infrequently presented in a manner and in a place that would make it immediately accessible to clinicians. Reports on clinical practice in different countries — possibly enriching knowledge by providing a range of experience and a powerful commentary on the applicability of research findings in everyday work — are not easily found in accessible psychiatric . . .

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