New concepts in the diagnosis and management of depression

The diagnosis and therapy of the depressive disorders has entered a new era in the 80s. Though primarily driven by breakthroughs in the neurosciences, such as neuroendocrinology, neurochemistry, and psychopharmacology, the increased sophistication of our diagnostic procedures and therapies of these disorders is by no means limited to the biomedical laboratory. A move away from preconceived concepts of the causes and course of depression has ushered in an era of empirical investigation of the clinical presentation and clinical course of the depressive disorders. This empirical approach has contributed to a new wave of epidemiologic investigations. The psychiatrist's diagnostic and therapeutic approach to the depressive disorders, more so than with any other primary psychiatric disorder, closely parallels the approach of physicians from other specialties, and has thereby increased the bond between psychiatry and the other medical specialties. Some caution, however, must be expressed. First, depressive disorders are considered by many primary care physicians to be easily understood and managed, or to be unworthy of serious attention. The requirement for specialty care in the management of treatment-resistant depressive disorders is as essential as the requirement for the coronary care unit in treating the unstable cardiac patient. In addition, the movement toward the medical management of the depressive disorders should not bias the clinician to the point that he neglects these illnesses and the patients who suffer them. We may view the depressive disorders as being primarily of biomedical causes, but patients still interpret their depressive symptoms within the context of their values, their lifestyles, and the events that impact them.(ABSTRACT TRUNCATED AT 250 WORDS)