A nosological review of depressive disorders based on observations in clinical practice, Part 1: terminology and phenomenology

Abstract

The purpose of this paper is to describe the problems with the contemporary nosology of 'depression' and to discuss the key linguistic and phenomenological aspects that are essential prerequisites for a clinically meaningful typology of depressive disorders. The paper comprises observations and reflections drawn from clinical work. First, the use of the unqualified, stock term 'depression' is counterproductive, as are the diagnostic non-entities of 'major depression' and 'dysthymia'. Second, the core psychopathology in melancholic depression is a loss of self-confidence, which helps explain the frequent co-occurrence of 'anxiety' with 'depression'. Third, descriptive, non-technical terms such as 'demoralisation' and 'grief' are most helpful in formulating non-melancholic forms of depression and thus useful in differential diagnosis.