What’s melancholy, really? If you are smack-dab in the middle of a month-long slump, does that make you depressed? And imagine if you lost a loved one? You could certainly feel extreme sadness, hopelessness, and maybe even a loss of motivation. However, is it actually depression?
Scientists, doctors, and blue people might never quit debating within the meaning of this elaborate mental health condition — but when in doubt, they could all rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM), a thick reference book for mental health professionals that identifies and classifies every single mental disorder, from depression to gender identity disorder.
Currently, the American Psychiatric Association (APA) is working on an updated version of the DSM, that will be known as DSM-5 and is expected to be released in 2013. The present “shrink’s bible” — the DSM-4 — has existed since 1994.
One suggestion for DSM-5 — to continue to exclude bereavement, or despair, included in the melancholy definition — has been met with controversy (and it’s not the only DSM-revision firestorm; last week, the discussion over an updated definition of autism, which will create one diagnostic group instead of three subtypes, made headlines).
The present definition of depression leaves out report that looked at whether the exception is valid.
Bereavement is left out so someone experiencing the typical symptoms of despair does not end up with an unwarranted analysis of depression.
However, some experts believe that excluding grief in the DSM5 is a huge error. “Melancholy can and does happen in the aftermath of bereavement, it might be serious and debilitating, and calling it by another name is doing a disservice to individuals who may need more careful focus,” Sidney Zisook, a psychiatrist at the University of California, San Diego, told The New York Times.
David J. Kupfer, PhD, agrees: “If someone is suffering from severe depression symptoms one or two months after a reduction or a death, and I can not make a diagnosis of depression — well, that’s not being clinically proactive. That individual may then not get the treatment they want,” he told the Times.
There is research on whether despair should really be diagnosable (and thus covered by insurance), as well as the DSM-5 Mood Disorders Work Group, the portion of the APA that’s proposed eliminating the “bereavement exclusion,” promises the research shows that it’s no longer justified.
In turn, Drs. Wakefield and First took a look at the research (including a 2007 study that found that despair-activated depression is similar to genuine melancholy and a 2010 review of ensuing research). Their judgment? To stop false-positive diagnoses, despair should indeed be excluded as a member of the depression definition in the DSM 5.
Nonetheless, they’ve proposed some advancements in the definition. For example: adding a provisional modifier that might help diagnose someone with lengthy grief-associated depression — continuing more than two months — and contemplating a patient’s history of major depression.
The APA jury’s still out on the grief-depression issue –their decision should come sometime in the following year. Meanwhile, if you’re grieving a significant loss, don’t hesitate to seek guidance from your physician if you think your despair may have turned into something more.
What would you believe? Should someone experiencing despair be treated for depression? Tell us in our comments section below.