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Depressions black and blue: changing the Zeitgeist

Gordon B Parker
Med J Aust 2003; 179 (7): . || doi: 10.5694/j.1326-5377.2003.tb05585.x
Published online: 6 October 2003

A new model of depression with meaningful subtypes will avoid simplistic treatments

When you hear the term “major depression”, you imagine a clinically meaningful entity. Think “pseudoentity”, know “paradigm failure”.1 If I took my tegument for dermatological inspection, a diagnosis of “major” or “minor” blotches would be uninformative. I would need more categorical information (eg, freckle, melanoma) to make rational treatment choices. However, non-specificity now rules in depression modelling and treatment.


  • Black Dog Institute, Prince of Wales Hospital, Randwick, NSW.


Correspondence: 

  • 1. Parker G. Classifying depression: should paradigms lost be regained? Am J Psychiatry 2000; 157: 1195-1203.
  • 2. World Health Organization Division of Mental Health. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: WHO, 1992.
  • 3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed (DSM-IV). Washington, DC: APA, 1994.
  • 4. Judd LL, Rapaport MH, Paulus MP, Brown JL. Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry 1994; 55 (4 Suppl): 18-28.
  • 5. Parker G, Anderson IM, Haddad P. Clinical trials of antidepressant medications are producing meaningless results. Br J Psychiatry 2003; 183: 102-104.
  • 6. Williams JW Jr, Mulrow C, Chiquette E, et al. A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med 2000; 132: 743-756.
  • 7. Kirsch I, Moore TJ, Scoboria A, Nicholls S. The Emperor’s new drugs: an analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevention & Treatment 2002; 5: 1-11.
  • 8. Khan A, Khan S, Brown WA. Are placebo controls necessary to test new antidepressants and anxiolytics? Int J Neuropsychopharmacol 2002; 5: 193-197.
  • 9. American Psychiatric Association. Practice guidelines for the treatment of psychiatric disorders. Compendium 2000. Washington, DC: American Psychiatric Association, 2000.
  • 10. Parker G, Roy K, Eyers K. Cognitive behavior therapy for depression? Choose horses for courses. Am J Psychiatry 2003; 160: 825-834.
  • 11. Huibers MJ, Beurskens AJ, Bleijenberg G, van Schayck CP. The effectiveness of psychosocial interventions delivered by general practitioners (Cochrane Review). The Cochrane Library, Issue 2 2003. Oxford: Update Software.

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