![]() ![]() Other aspects of depression such as response to treatment (for example, treatment resistant, refractory) and aetiology (for example, preceding life events) do not feature specifically in the classifications and lack accepted definitions, although are used in clinical practice. These have defined a threshold of severity of clinical significance with further classification in terms of severity (for example, mild, moderate or severe as adopted in DSM–IV with regard to major depressive disorder), duration and course of the disorder (for example, recurrent, presence of residual symptoms) and subtype based on symptom profile (for example, melancholic, atypical). Over time pragmatic definitions have emerged, enshrined in the current two major classification systems, DSM–IV ( APA, 2000a) and ICD–10 ( WHO, 1992). These have been based on varying combinations of the nature, number, severity, pattern and duration of symptoms, and in some cases the assumed aetiology. A number of classification systems/subgroupings have been used, including reactive and endogenous depression, melancholia, atypical depression, depression with a seasonal pattern/seasonal affective disorder and dysthymia. Despite considerable work on the aetiology of depression including neurobiological, genetic and psychological studies, no reliable classificatory system has emerged that links either to the underlying aetiology or has proven strongly predictive of response to treatment. ![]() EXTREME DEPRESSIVE EPISODE UPDATEThis appendix sets out an approach to the classification of depression that was used in the development of this guideline and the depression guideline update ( NCCMH, 2010) (including the analysis of the evidence and the development of recommendations) and will be of value in routine clinical use.ĭepression is a heterogeneous disorder in which a number of underlying presentations may share a common phenomenology but have different aetiologies. ![]()
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