ABSTRACT
Depression is one of the most commonly used terms to describe someone’s mental state, ‘I’m really depressed today’ or ‘He’s suffering from depression’. Clearly, it has connotations for the lay person of indicating low mood but is used without very much precision; little differentiation is made between a transient feeling of unhappiness and a serious and persistent problem that leads to a person seeking help. ICD-10 groups together a range of conditions described as depressive episode, recurrent depressive episode and mixed anxiety and depressive disorder, and DSM-IV uses a similar system of classification. What links these disorders under the umbrella of depression is a range of mental health problems characterised by low mood and loss of enjoyment or interest in everyday events, and an associated range of emotional, cognitive, physical and behavioural signs (National Collaborating Centre for Mental Health 2004: 14). Making a clear differentiation between the lay understanding of depression and a state of mind that reaches a clinical threshold of diagnosis as a clinical condition is elusive; the boundary is permeable but depends on judgement about the severity and intractability of the person’s mood. ICD-10 categorises depression according to the number of symptoms that an individual presents as to whether it is mild, moderate, severe or psychotic. This appears a very reductionist approach based on seemingly arbitrary judgements about thresholds. In its guidance for the management of depression in primary and secondary settings NICE suggests that the categories of recurrent, treatment resistant, chronic, atypical and psychotic depression could be more useful (National Collaborating Centre for Mental Health 2004: 49).
