In terms of DSM-IV criteria, a diagnosis of Major Depression requires evidence of at least one primary symptom and at least four associated symptoms lasting nearly every day for at least two weeks. Depressed mood and a distinct loss of interest or pleasure in most or all activities (anhedonia) count as primary symptoms. The secondary symptoms are: (a) appetite disturbance or weight change; (b) sleep disturbance; (c) psychomotor agitation or retardation; (d) fatigue or loss of energy; (e) feelings of worthlessness or guilt; (f) diminished concentration or decision-making ability, (g) thoughts of death or suicide.
DSM-IV distinguishes between Major Depression and a range of other mood disorders including Dysthymic Disorder and Bipolar I Disorder. This range of classifications attempts to encompass the variety of presentations of significant depressive mood. Current thinking (e.g. Parker, 1996) emphasizes that the notion of depression includes a range of disorders: 'As ''depression'' encompasses heterogeneous conditions, single answers should not be sought'. Parker (1996) distinguishes between melancholic and non-melancholic depression in his challenge to current thinking about responsiveness to antidepres-sant medication and other treatments for depression. He argues that: 'Any study which amalgamates separate depressive subgroups, rapid and slow remitters, will give limited information as the ''group'' trajectory subsumes a set of potentially distinctly different trajectories'. Such thinking warns us against responding to depression as if it were a unitary construct and against too readily attempting to make generalizations about individuals struggling with depression.
Very little useful comparison can be made between treatment accounts unless some objective measure of depression has been utilized. Whilst the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) are extensively used in research studies, they are only rarely utilized in the body of case accounts that form the data base in this area.
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