Wednesday, 30 January 2013
There has been much to-do about the newest version of the Diagnostic and Statistical Manual (DSM), the book used by the majority of clinicians to recognize and diagnose mental disorders. The latest edition will be published in May. The proposed changes have stirred up quite a bit of controversy. One of the many revisions found in the DSM-5 is the change to the diagnostic criteria for major depression.
In the current version, DSM IV-TR, patients being considered for a diagnosis of major depression had to display 2 of 3 criteria; depressed mood, anhedonia (lack of interest in activities previously enjoyed), and reduced energy. Bereavement is noted as a potential contributing factor for major depression, but clinicians are discouraged from diagnosing major depression unless the symptoms of depression following a loss last for a minimum of 2 months. Bereavement on its own is called a “v” code, and usually is not billable to insurance companies.
In the DSM 5, the diagnostic criteria for major depression was adjusted, and the “bereavement exclusion,” the paragraph stating that the symptoms of major depression after a loss must be present for a minimum of 2 months to qualify for diagnosis, was removed.
Many writers, doctors, and clinicians have weighed in on the change. Several people believe that the change is a positive move, allowing older adults to qualify for a diagnosis, and not have their depression written of as a “normal” stage of aging. But some believe the change may lead to depression being overdiagnosed. One such critic, Allen Frances, who chaired the task force behind the last DSM (the DSM IV-TR), fears that grieving adults may be prescribed antidepressants they don’t need. He says “Most people get better with time and natural healing and resilience…[the change] gives the drug companies the right to peddle pills for grief.”
Psychology Today’s blogger, Dr. Stephen Diamond, agreed that there is now a risk of overdiagnosis and overprescribing antidepressants, but challenged prescribers and treaters to overcome their reliance on prescribing medication, and to use clinical judgment when making such decisions. He says “there is nothing in the DSM-IV-TR or forthcoming DSM-5 (so far as I know) that dictates or even recommends medicating patients. The decision to do so depends solely upon the treating physician or clinican. And these decisions are informed (or misinformed) not merely by a diagnosis per se, but by the way clinicians interpret and understand the underlying nature of a patient's symptomatology.”
In summary, because of the changes in the DSM 5, a grieving adult with symptoms of major depression will not have to suffer for 2 months before receiving appropriate treatment. However, the provider’s understanding of their patient’s depressive symptoms and how those symptoms relate to the patient’s underlying grief is a critical factor in determining whether a major depression diagnosis is appropriate.
Sources: Grief Over New Depression Diagnosis, Paula Span, New York Times Health, 1/24/2013
DSM-5 Hysteria: When Normal Mourning Becomes Neurotic Bereavement, Dr. Stephen Diamond, Psychology Today, 2/19/2012