Diagnosing major depressive disorder VIII: are some symptoms better than others?

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project examined whether symptoms that are not part of the DSM-IV definition of major depressive disorder (MDD) are better at discriminating depressed from nondepressed patients than the current criteria. Symptoms assessed included diminished drive, helplessness, hopelessness, nonreactive mood, psychic anxiety, somatic anxiety, subjective anger, and overtly expressed anger. A total of 1538 psychiatric outpatients were administered a semistructured diagnostic interview. We inquired about all of the symptoms of depression for all patients. Diminished drive exhibited stronger performance in differentiating MDD from non-MDD relative to all DSM-IV criteria except depressed mood, reduced interest/pleasure, and impaired concentration/indecisiveness. A compound criterion combining diminished drive with loss of energy was endorsed by nearly all MDD patients. Helplessness and hopelessness, when combined into a single criterion, performed more strongly than some of the DSM-IV criteria. Lack of reactivity, anxiety, and anger symptoms failed to differentiate more strongly than current DSM-IV criteria. The implications of these results for revising the diagnostic criteria for major depression are discussed.