Problems with diagnostic criteria for depression.
Limitations of the three major psychiatric diagnostic systems are discussed, with particular reference to depression and its subtypes. The lack of demonstrated reliability and validity for standard diagnoses, and the use of these diagnoses as independent variables in clinical research, is criticized. Possible approaches to improving current classification methods include increased specificity and sensitivity of symptoms, differential weighting, and objective recording. Scientific validation procedures should be applied to the classification of depressions, including studies of natural history and course, specific antidepressant drug responses, and the use of laboratory markers such as the dexamethasone suppression test and sleep EEG parameters.
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