Depression - Unspecified

Some professionals portray this category as a "garbage pail" diagnostic category for depression. That is an incoreect assessment of the category. If someone is obviously depressed, but does not fit into any of the other categories, then this diagnosis is made. However, it is not a garbage pail, but provides a valuable way to categorize depression that does not fit into the other categories. The alternative would be to have several additional diagnostic categories. That is not useful, unless the different diagnoses require different treatment. This category includes people with serious depression, but not quite severe enough for a diagnosis of a major depression, so moderate depression would be included here. This would also include people with mild to moderate depression who have not been depressed long enough to be diagnosed with a dysthymic disorder. Dysthymic disorder requires depressive symptoms to be present for two years. It also includes those individuals who continue to be depressed, in response to some traumatic event, but the depression has lasted longer than expected for an adjustment disorder with depression. In an adjustment disorder, the expectation is that the depression will last no more than about six months after the stressor has ended.

Treatment for Depression

The treatment plan remains the same as for other depressive disorders. Cognitive psychotherapy is effective in reducing depressive symptoms, and the cognitive distortions that appear to cause the mood problem. Interpersonal psychotherapy is used to help the individual resolve relationship problems that are causing the depression. If the symptoms are severe, the individual may be referred for a medical evaluation to assess the need for medication, but in most cases medication is not necessary.

These different diagnostic categories of depression are sometimes more useful for research purposes than for treatment purposes. When making distinctions between different categories within a particular class of disorders, such as depression, psychologists are looking for differences that may indicate different causes, or that require different treatment.

Also, in completing research on treatment for a specific category of depression, the differences become important in measuring the results of treatment. For example, if a study is comparing different treatments, it is important that the treatment groups are similar. We would not want one treatment group to include mostly people with a major depression and another group to include mostly people with an adjustment disorder. If that happened, the research results would be tainted. Generally, moderate depression requires less treatment, and responds better to treatment, than severe depression. If we are comparing different types of treatment, the different treatments must be applied to similar problems. 

To some extent then, the use of a diagnosis helps the psychologist predict the expected duration of treatment, or to anticipate possible issues that might arise in treatment. The history of symptoms, especially the duration of the depression, can help a psychologist understand the overall impact of the depression on a person's life. Someone who has been depressed for many years, either with dysthymic disorder or recurrent major depression, will have a multitude of issues related to how the disorder has taken over his/her life. This is very different than the clinical picture presented when a person becomes depressed initially after a specific trauma, and recovers. 

For more information, contact Dr Franklin at (908) 526-8111