Moving ahead yet falling behind. A critical appraisal of some trends in contemporary depression research

The progress of psychiatry over the past few years is impressive. That process, however, is nonlinear and in this paper three developments in depression research are discussed and thought to be counterproductive. First, the depression classification as institutionalized by the DSM-III is an unfocused and confusing one. The regular revisions, moreover, largely based on the opinions of experts rather than on the research by experts, add to the confusion. Second, the preoccupation of biological psychiatry with nosology is seen as a growth-inhibiting factor. The functional/dimensional approach searching for correlations between biological and psychological dysfunctions, an approach we have been advocating for many years, seems to have great potential and deserves to be included in mainstream biological psychiatry. Finally, the 'biologization' of depression research went too far. The conception of depression as a brain disease is a 'terrible simplification', even for the syndrome considered to be the most 'biological' of all: major depression, melancholic type. Psychological determinants of the brain dysfunctions underlying depressive disorders deserve as much scientific scrutiny as their biological counterparts. The mind should not be the soft belly of (biological) psychiatry.