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Are the ICD-10 or DSM-5 diagnostic systems able to define those who will benefit from treatment for depression?

Published online by Cambridge University Press:  15 July 2016

Stuart Montgomery
Stuart Montgomery*
Affiliation:
Department of Psychiatry, Imperial College, London, UK
*
*Address for correspondence: Stuart Montgomery, Imperial College London, PO Box 8751, London W13 8WH, UK. (Email: [email protected])
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Abstract

Two widely used diagnostic systems, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are reviewed for their ability to define those who will benefit from active treatment rather than placebo. Both systems suffer from a weakness in defining symptoms sufficiently clearly to separate depression from normal mood variations in the general population. Consequently, normal individuals may be medicalized and defined as suffering from and treated for depression. Also, in mild depression, unlike moderate depression, a lack of significant separation of active treatment from placebo has been shown in individual double-blind, placebo-controlled studies and in meta-analyses of these treatment studies. Both systems would be more useful for treatment purposes if they provided a clearer symptomatic definition of moderate depression, as is widely used in pivotal regulatory standard efficacy studies.

Keywords

DepressionDSM-5ICD-10treatmentweaknesses
Type
Opinions
Information
CNS Spectrums , Volume 21 , Special Issue 4: Nosology in DSM5 vs. ICD , August 2016 , pp. 283 - 288
Copyright
© Cambridge University Press 2016 

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References

1. World Health Organization (WHO). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. Geneva: World Health Organization; 2003.Google Scholar
2. World Health Organization (WHO). International Classification of Diseases and Related Health Problems. 10th rev. Geneva: World Health Organisation; 1992.Google Scholar
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.Google Scholar
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.Google Scholar
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
6. Bandelow, B, Reitt, M, Röver, C, Michaelis, S, Görlich, Y, Wedekind, D. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015; 30(4): 183–192.Google Scholar
7. Montgomery, SA. Measures of Depression. London: Fulcrum Press; 1978.Google ScholarPubMed
8. Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134(4): 382–389.Google Scholar
9. Montgomery, SA. The efficacy of fluoxetine as an antidepressant in the short and long term. Int Clin Psychopharmacol. 1989; 4(Suppl 1): 113–119.Google Scholar
10. Dunlop, SR, Dornseif, BE, Wernicke, JF, Potvin, JH. Pattern analysis shows beneficial effect of fluoxetine treatment in mild depression. Psychopharmacol Bull. 1990; 26(2): 173–180.Google ScholarPubMed
11. Stassen, HH, Angst, J, Delini-Stula, A. Severity of baseline and onset of improvement in depression: metanalysis of imipramine and moclobemide versus placebo. Eur Psychiatry. 1994; 9(Suppl. 3): 129–136.CrossRefGoogle Scholar
12. Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008; 5(2): e45.CrossRefGoogle ScholarPubMed
13. Schweizer, E, Rynn, M, Mandos, L, Demartinis, N, Garcia-Espana, F, Rickels, K. The antidepressant effect of sertraline is not enhanced by dose titration: results from an outpatient clinical trial. Int Clin Psychopharmacol. 2001; 16(3): 137–143.Google Scholar
14. Licht, RW, Qvitzau, S. Treatment strategies in patients with major depression not responding to first-line sertraline treatment: a randomised study of extended duration of treatment, dose increase or mianserin augmentation. Psychopharmacology (Berl). 2002; 161(2): 143–151.CrossRefGoogle ScholarPubMed
15. Wernicke, JF, Bosomworth, JC, Ashbrook, E. Fluoxetine at 20 mg per day. I. The recommended and therapeutic dose in the treatment of depression. Int Clin Psychopharmacol. 1989; 4(Suppl 1): 63–68.Google Scholar
16. Ruhé, HG, Huyser, J, Swinkels, JA, Schene, AH. Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review. J Clin Psychiatry. 2006; 67(12): 1836–1855.CrossRefGoogle ScholarPubMed
17. Bschor, T, Baethge, C. No evidence for switching the antidepressant:systematic review and meta-analysis of RCTs of a common therapeutic strategy. Acta Psychiatr Scand. 2010; 121(3): 174–179.Google Scholar
18. Souery, D, Serretti, A, Calati, R, et al. Switching antidepressant class does not improve response or remission in treatment-resistant depression. J Clin Psychopharmacol. 2011; 31(4): 512–516.CrossRefGoogle ScholarPubMed
19. Souery, D, Serretti, A, Calati, R, et al. Citalopram versus desipramine in treatment resistant depression: effect of continuation or switching strategies: a randomized open study. World J Biol Psychiatry. 2011; 12(5): 364–375.Google Scholar
20. Guy, W. ECDEU Assessment Manual for Psychopharmacology. Rev ed. Rockville, MD: National Institute of Mental Health; 1976.Google Scholar
21. Frances, AJ, Nardo, JM. ICD-11 should not repeat the mistakes made by DSM-5. Br J Psychiatry. 2013; 203(1): 1–2.Google Scholar