Definition of "clinical depression" 
Author Message
 Definition of "clinical depression"

I am a little confused about the definition of "clinical depression".
Based on my personal experiences it has to be either:

1. Fatigue the cause of which does not show up on a the following
tests:  Chem 20, CBC, thyroid panel, and sed rate.

2. The condition of having an MD say: "You are depressed".

Which of these are the correct definition?  Thank you in advance for
all replies.  
--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.



Tue, 12 Oct 2004 12:43:45 GMT
 Definition of "clinical depression"

Quote:
> 1. Fatigue the cause of which does not show up on a the following
> tests:  Chem 20, CBC, thyroid panel, and sed rate.

No, definitely not.  Depression is a psychiatric (psychological) disease
that is a syndrome of characteristic mental function alteration.  Certainly
these tests could be useful to diagnose a disease that might mimic
depression, but absence of organic disease in the presence of fatigue is
totally insufficient for a diagnosis.

Quote:
> 2. The condition of having an MD say: "You are depressed".

Hopefully the MD will have made the diagnosis correctly, so this is probably
a reliable sign.


Tue, 12 Oct 2004 17:27:30 GMT
 Definition of "clinical depression"

Quote:

>I am a little confused about the definition of "clinical depression".
>Based on my personal experiences it has to be either:

>1. Fatigue the cause of which does not show up on a the following
>tests:  Chem 20, CBC, thyroid panel, and sed rate.

>2. The condition of having an MD say: "You are depressed".

>Which of these are the correct definition?  Thank you in advance for
>all replies.  

        Actually neither: From the Mental Health Association's
website
Symptoms of clinical depression

                A persistent sad, anxious or "empty" mood
                Sleeping too little or sleeping too much
                Reduced appetite and weight loss, or increased appetite and
weight gain
                Loss of interest or pleasure in activities once enjoyed
                Restlessness or irritability
                Persistent physical symptoms that don't respond to treatment
[such as headaches, chronic
                pain, or constipation and other digestive disorders]
                Difficulty concentrating, remembering, or making decisions
                Fatigue or loss of energy
                Feeling guilty, hopeless or worthless
                Thoughts of death or suicide

      This is the URL for a SCREENING (NOT diagnostic) test that
seems good.
http://nano.xerox.com/pair/cw/testing.html

----------------------------------
This mail is a natural product.  The slight variations in spelling and
grammar enhance its individual character and beauty and in no way are to
be considered flaws or defects.



Tue, 12 Oct 2004 19:57:24 GMT
 Definition of "clinical depression"
There are two sets of definitions depending on the convention you
follow. US psychiatrists tend to use DSM-IV while UK psychiatrists
prefer ICD-10. They are pretty similar but don't always overlap.

DSM-IV: Major depression with melancholia
-----------------------------------------
Lasting nearly for every day more than 2 weeks.

2 Core symptoms:
- Lack of interest or pleasure in usual activities
- Lack of reactivity to pleasurable stimuli
(ie aspects of anhedonia)

plus at least 3 of the following:
- Distinct quality of mood
- Morning worsening of mood
- Early morning waking
- Psychomotor agitation or retardation (ie. blunting of affect)
- Significant anorexia or weight loss
- Excessive guilt

ICD-10: Depressive episode with somatic symptoms
------------------------------------------------
Lasting nearly every day for more than 2 weeks.

At least 4 of the following:
- Lack of interest or pleasure in usual activities (anhedonia)
- Lack of reactivity to pleasurable stimuli (anhedonia)
- Morning worsening of mood
- Early morning waking
- Psychomotor agitation or retardation (ie. blunting of affect)
- Significant anorexia or weight loss
- Excessive guilt
- Marked loss of libido

---------------------------------------------------

Other features which aid in diagnosis but are not in the criteria are:
- pessimistic thoughts (depressive cognition) on the present, future
and past. This can lead on to suicidal ideation.
- delusions of guilt, imporverishment, hypochondrial, persecutory or
nihilism. A lot of weird and wonderful syndromes here.
- pseudohallucinations. These are perceptions of vivid mental images
which the patient is aware does not correlate with external reality.



Tue, 12 Oct 2004 21:10:27 GMT
 Definition of "clinical depression"

Quote:

>> 1. Fatigue the cause of which does not show up on a the following
>> tests:  Chem 20, CBC, thyroid panel, and sed rate.

>No, definitely not.  Depression is a psychiatric (psychological) disease
>that is a syndrome of characteristic mental function alteration.  Certainly
>these tests could be useful to diagnose a disease that might mimic
>depression, but absence of organic disease in the presence of fatigue is
>totally insufficient for a diagnosis.

>> 2. The condition of having an MD say: "You are depressed".

>Hopefully the MD will have made the diagnosis correctly, so this is probably
>a reliable sign.

What is the correct way of making the diagnosis?
--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.


Mon, 18 Oct 2004 02:32:51 GMT
 Definition of "clinical depression"


Quote:

>>Hopefully the MD will have made the diagnosis correctly, so this is probably
>>a reliable sign.

>What is the correct way of making the diagnosis?

See the ICD-10 and DSM-IV criteria in my other post. That is the
formal criteria used by psychiatrists for diagnosis. The average GP
and family doctor usually only uses the criteria loosely and makes a
guesstimate of the diagnosis.


Mon, 18 Oct 2004 07:57:48 GMT
 Definition of "clinical depression"

Quote:




>>>Hopefully the MD will have made the diagnosis correctly, so this is
probably
>>>a reliable sign.

>>What is the correct way of making the diagnosis?

>See the ICD-10 and DSM-IV criteria in my other post. That is the
>formal criteria used by psychiatrists for diagnosis. The average GP
>and family doctor usually only uses the criteria loosely and makes a
>guesstimate of the diagnosis.

Which is not to be poo-pooed, since a guestimate of a diagnosis is not
necessarily better than a mathematically precise tabulation of a bunch of
criteria which are themselves guesstimates and artistic judgements. There's
nothing sacred about DSM IV. There's nothing even clinically predictive
about it. Any anybody proven that people who tell you that they're really
depressed and don't feel like living, are any less likely to shoot
themselves or need to be hospitalized (or you pick the criterion) than
people who meet the formal scoring conditions for DSM but refuse to admit
they are depressed?  I don't think so.

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.



Mon, 18 Oct 2004 08:52:05 GMT
 Definition of "clinical depression"

Quote:





>>>>Hopefully the MD will have made the diagnosis correctly, so this is
>probably
>>>>a reliable sign.

>>>What is the correct way of making the diagnosis?

>>See the ICD-10 and DSM-IV criteria in my other post. That is the
>>formal criteria used by psychiatrists for diagnosis. The average GP
>>and family doctor usually only uses the criteria loosely and makes a
>>guesstimate of the diagnosis.

>Which is not to be poo-pooed, since a guestimate of a diagnosis is not
>necessarily better than a mathematically precise tabulation of a bunch of
>criteria which are themselves guesstimates and artistic judgements. There's
>nothing sacred about DSM IV. There's nothing even clinically predictive
>about it. Any anybody proven that people who tell you that they're really
>depressed and don't feel like living, are any less likely to shoot
>themselves or need to be hospitalized (or you pick the criterion) than
>people who meet the formal scoring conditions for DSM but refuse to admit
>they are depressed?  I don't think so.

Are you claiming that when an M.D. makes a diagnosis of depression
that he/she is ALWAYS correct and that if the patient thinks that they
are not depressed they are in denial?
--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.


Mon, 18 Oct 2004 12:49:38 GMT
 Definition of "clinical depression"

Quote:




>>>Hopefully the MD will have made the diagnosis correctly, so this is probably
>>>a reliable sign.

>>What is the correct way of making the diagnosis?

>See the ICD-10 and DSM-IV criteria in my other post. That is the
>formal criteria used by psychiatrists for diagnosis. The average GP
>and family doctor usually only uses the criteria loosely and makes a
>guesstimate of the diagnosis.

What is the correct way to determine if someone meets the ICD-10 and
DSM-IV criteria?
--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.


Mon, 18 Oct 2004 12:49:39 GMT
 Definition of "clinical depression"

Quote:
> Which is not to be poo-pooed, since a guestimate of a diagnosis is not
> necessarily better than a mathematically precise tabulation of a bunch of
> criteria which are themselves guesstimates and artistic judgements.

This bit I agree with.

Quote:
> nothing sacred about DSM IV. There's nothing even clinically predictive
> about it.

Hang on.  There are plenty of issues where a refined diagnosis predicts
prognosis, probability of treatment success, etc.  For example, paedophiles
attracted to males are significantly less likely to benefit from treatment
than paedophiles attracted to females.  Making the distinction part of the
diagnostic code is, to my knowledge, unique to DSM.

Quote:
> Any anybody proven that people who tell you that they're really
> depressed and don't feel like living, are any less likely to shoot
> themselves

Yeah.  Suicide rate in the general community is less than 1% per lifetime.
Suicide rate in depression is 10-15%.  Suicide rate in bipolar disorder is
~25%.  That's in Australia.  It's probably different in the US, where
suicide is more common overall.


Mon, 18 Oct 2004 16:35:34 GMT
 Definition of "clinical depression"

Quote:
> Are you claiming that when an M.D. makes a diagnosis of depression
> that he/she is ALWAYS correct

No one can claim that, of course.

Quote:
> and that if the patient thinks that they
> are not depressed they are in denial?

If a person satisfies the DSM criteria for depression, I'd say there's a
99.5% chance that the person has the same disease as those people who are
diagnosed with 'depression'.  Part of the diagnostic criteria is that the
symptoms are not better accounted for by a general medical illness, or by
another psychiatric illness.


Mon, 18 Oct 2004 16:37:53 GMT
 Definition of "clinical depression"

Quote:
> What is the correct way to determine if someone meets the ICD-10 and
> DSM-IV criteria?

If a person is not a doctor:  Take them to a doctor.

If the person is a doctor: Take a full history from the patient, complete a
full examination, investigate the patient as necessary to establish that
there is no organic basis for the symptoms (like anaemia, hypothyroidism,
etc).  Whip out the list, and ask the specific questions in order.  I know I
do.  The physicians are most amused when I give them a score out of 7 for
the patient's depressive symptoms.  Unlike most people, I screen most
patients for depression.  I think it's rather common in hospitals.



Mon, 18 Oct 2004 16:41:40 GMT
 Definition of "clinical depression"

Quote:

>> Are you claiming that when an M.D. makes a diagnosis of depression
>> that he/she is ALWAYS correct

>No one can claim that, of course.

>> and that if the patient thinks that they
>> are not depressed they are in denial?

>If a person satisfies the DSM criteria for depression, I'd say there's a
>99.5% chance that the person has the same disease as those people who are
>diagnosed with 'depression'.  Part of the diagnostic criteria is that the
>symptoms are not better accounted for by a general medical illness, or by
>another psychiatric illness.

Does the "general medical illness" you mention above have to be one
that has been detected by the doctor or can it be an undetected
illness?  For example, if someone has symptoms that are more
consistent with a chronic infection but no infection is detected by
the doctor.

--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.



Tue, 19 Oct 2004 01:57:09 GMT
 Definition of "clinical depression"

Quote:

>> What is the correct way to determine if someone meets the ICD-10 and
>> DSM-IV criteria?

>If the person is a doctor: Take a full history from the patient, complete a
>full examination, investigate the patient as necessary to establish that
>there is no organic basis for the symptoms (like anaemia, hypothyroidism,
>etc).  Whip out the list, and ask the specific questions in order.  

What if the doctor takes a superficial history, does a superficial
examination, runs a Chem 20, CBC, thyroid panel, and sed rate and
doesn't ask the questions on the list?  Would that be a valid
diagnosis?

I know I

Quote:
>do.  The physicians are most amused when I give them a score out of 7 for
>the patient's depressive symptoms.  Unlike most people, I screen most
>patients for depression.  I think it's rather common in hospitals.

--
My previous cat, Rocket would play "monster" with me.  I would
assume the threat posture of a bear and make a scarry noise (usually
"BAROO BAROO") and chase him around the apartment.  If I try it with
my present cat Marmaduke he attacks my leg instead of running.


Tue, 19 Oct 2004 02:12:08 GMT
 Definition of "clinical depression"

Quote:

>What if the doctor takes a superficial history, does a superficial
>examination, runs a Chem 20, CBC, thyroid panel, and sed rate and
>doesn't ask the questions on the list?  Would that be a valid
>diagnosis?

    What if the doctor takes off all of his clothes (or hers to not be
sexist), begins mumbling something in Swahili (with a southern Georgia
accent), sacrifices three chickens, two snakes and left handed wildebeast to
the Gods of All Things Chicago Cubbish. Would that be a valid diagnosis?

Kurt (Gee lets see, pretty much ignore everything that was postulated to be
needed for a valid diagnosis and then ask if it was a valid diagnosis. I
suppose there was a point in there somewhere) Ullman

----------------------------------
This mail is a natural product.  The slight variations in spelling and
grammar enhance its individual character and beauty and in no way are to
be considered flaws or defects.



Tue, 19 Oct 2004 04:18:40 GMT
 
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