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New Definition of Depression Includes Sustained Grief

Major depression is a life-altering mental health disorder that affects children, teenagers and adults. However, for a number of reasons, older adults with depression-related symptoms often don’t receive a depression diagnosis. In order to at least partially rectify this situation (and accomplish a number of other goals), the organization responsible for creating the standard definition for major depression in the United States will modify that definition in 2013. The main result of this modification will be an expanded ability for doctors to officially diagnose depression symptoms that occur during periods of grief or emotional bereavement.

Background Information

The organization that creates the basic standards for mental illness in the U.S. is called the American Psychiatric Assn. Periodically, this group releases updated versions of a guide called the Diagnostic and Statistical Manual of Mental Disorder, or DSM, which contains the mental health categories commonly used by doctors, researchers, insurance companies and government agencies. Prior to 2013, the most recent full version of the DSM—called DSM IV or DSM 4—appeared in 1994; a partial update of this edition was issued in 2000. The American Psychiatric Assn. will release a new edition of the manual, called DSM 5, in May 2013.

Depression Definition in DSM 4

According to the guidelines established in DSM 4, an affected individual can be diagnosed with major depression if he or she has at least five symptoms that last for a minimum of two weeks. Examples of the relevant symptoms include sleep disturbances, a “down” emotional state, a diminished ability to feel pleasure, unexplained tiredness, a reduced ability to think clearly, a recurring preoccupation with suicide, unintentional and/or uncharacteristic weight loss, the presence of uncontrolled or aimless body movements (a phenomenon known as psychomotor agitation), and the recurring or constant presence of strongly “negative” emotions such as worthlessness, hopelessness, guilt, sadness or helplessness. Critically, the DSM 4 definition of major depression cautions doctors against viewing these symptoms as depression symptoms when they occur in a two-month window after the death of a loved one. The main exception to this grief or bereavement clause is the presence of symptoms related to suicide.

Grief Basics

Grief is the natural, intense reaction that arises in the aftermath of a major loss, especially a loss that involves a loved one or other close associates. Specific manifestations of this reaction vary from person to person, but it typically includes an intense emotional response, as well as significant changes in one’s behavior, body function, thought processes and ability to interact with others. Generally acknowledged steps in the grieving process include an initial sense of shock and a denial of the loss, a subsequent preoccupation with aspects or details of the loss, a period filled with despair and other emotional states normally associated with depression, and an eventual recovery of a functional state of mental/emotional equilibrium. Generally speaking, grief is viewed as an emotionally healthy and necessary response to loss; doctors typically view it as problematic only when it lasts for extended periods of time or includes suicidal thoughts or actions.

Modified Depression Definition in DSM 5

The new definition of major depression in DSM 5 will effectively eliminate the two-month grief or bereavement clause that exists in DSM 4. In part, this modification is designed to address depression-related symptoms in older adults who generally have increased chances of dealing with the death(s) of one or more loved ones, in addition to grappling with issues regarding their own mortality. Paradoxically, doctors in past generations sometimes discounted the impact of death on older individuals because it was viewed simply as “part of life.” However, modern medical views on depression in the elderly have changed dramatically, and the American Psychiatric Assn. does not want doctors to underestimate the potential mental health consequences of frequent exposure to grief and mortality.

Concerns

Some mental health experts disagree with the expanded definition of major depression that will go into effect with the release of DSM 5. In large part, this disagreement stems from a fear that doctors will inadvertently use the new definition to diagnose depression in people who are merely going through the natural steps of the grieving process. Since depression is treated with powerful antidepressant medications, such a misdiagnosis could lead to an improper use of these medications, as well as an unwarranted increase in the amount of antidepressant medications used throughout the United States.

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