[Revised Dutch GP guideline 'Depression': diagnosis not as simple as it appears]

The revised Dutch guideline on depression in primary care is excellent. However, there is potential for misinterpretation when counting symptoms - an essential part of diagnosis. In the DSM-IV twenty-one symptoms are classified into 9 clusters. When using this guideline, it is possible to read 'decreased energy or tiredness', not 'and', so the 'or' leads to counting 2 symptoms instead of 1. Symptoms important for diagnosis include a period of at least 2 consecutive weeks during which mood is either depressed or there is loss of interest or pleasure in activities which persists for most of the day, nearly every day. This indicates low reactivity. If these decision rules are not properly understood too many diagnoses of depression may be made. The guideline pays no attention to personality problems, enabling patients to attribute their symptoms to problems of life and thus rule out their own behaviour. To make them responsible for their own actions in as far as this is possible, will be difficult.