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Kang and Kim: A Historical Consideration of Psychiatric Diagnostic Systems : Focusing on the Concept of Depression


Today's diagnostic criteria are based on consensus, however, they are still incomplete and being changed. These unstable but temporarily dogmatic criteria have been constraining the thinking of individual psychiatrists, and invalidating painful scientific achievements based on previous ones. The limitation of the criteria system appears especially clear concerning depression due to the ambiguity of its definition. Therefore, the aim of this article was to review the history of various concepts of depression and to compare this to today's tendency, which attempts to consolidate diversity. In addition to all Diagnostic and Statistical Manual (DSM), Internal Classification of Diseases (ICD)-9, ICD-9-CM, and ICD-10 were centrally discussed. Classic descriptions of depression were extracted from reviews of classic literature, and some salient concepts and the process by which they had been integrated, divided, and newly proposed was traced. The descriptions of depression whose prototype had been melancholia have experienced significant conceptual changes through DSM-IV and the most recent DSM-V ; they impose tasks that are yet to be resolved. Among them, whether various depressive syndromes are diverse phenotypes of one disorder or they all represent different disorders could be regarded as the most fundamental problem. In order to conduct fruitful studies and to ensure proper treatment of every patient, more precise nosologic understanding of depression must be pursued.

Figures and Tables

Fig. 1
A hierarchical model of depression syndromes. There are multiple processes and multiple markers but they have a common pathway to phenomenologic depression. However, depression syndromes on the lower hierarchy cannot manifest themselves in a severe pathology, while those on the higher hierarchy can have a mild pathology [Modified from Parker (2000)34)].
Fig. 2
A Schematic representation of the relationship between various depressive syndromes implicated in the DSM system. * : In DSM-5, the chapter "Mood disorders" is not used anymore and depressive and bipolar disorders became totally separated. MDD : Major depressive disorder, BP : Bipolar, DSM : Diagnostic and Statistical Manual.
Fig. 3
Unipolar depression vs. bipolar depression. UD : Unipolar depression, BD : Bipolar depression, MDE : Major depressive episode.
Table 1
Diagnostic criteria for melancholia and related conditions

RDC : Research Diagnostic Criteria, DSM : Diagnostic and Statistical Manual, ICD : Internal Classification of Diseases

Table 2
Items from CORE scale39)
Table 3
Course and outcome patterns of depression [Modified from Akiskal (2002)44)]
Table 4
A proposed "probabilistic" approach to the diagnosis of bipolar I depression in a person experiencing a major depressive episode with no clear prior episodes of mania [Modified from Mitchell et al.(2008)45)]

* : The specific number of items needed for diagnostic consideration requires further studies, : Confirmation of these specific numbers requires further studies

Table 5
Kendell's criteria for validating clinical syndromes103)
Table 6
DSM-IV-TR criteria for depressive personality and dysthymic disorder

DSM : Diagnostic and Statistical Manual

Table 7
Depressive disorders in DSM-I
Table 8
Characteristics of DSM-I depressive disorders

MDD : Major depressive disorder, MnDD : Minor depressive disorder, PD : Personality disorder, DSM : Diagnostic and Statistical Manual

Table 9
Depressive disorders in DSM-II

DSM : Diagnostic and Statistical Manual

Table 10
Depressive disorders in DSM-III

DSM : Diagnostic and Statistical Manual

Table 11
Depressive disorders in DSM-III-R

DSM : Diagnostic and Statistical Manual, NOS : Not otherwise specified

Table 12
Depressive disorders in DSM-IV

MRE : Most recent episode, NOS : Not otherwise specified, DSM : Diagnostic and Statistical Manual

Table 13
Depressive disorders in DSM-V

* : Includes chronic major depressive disorder, : Diagnose with depressive disorder if complicated. DSM : Diagnostic and Statistical Manual, ICD : Internal Classification of Diseases

Table 14
Depressive disorders in ICD-9

ICD : Internal Classification of Diseases

Table 15
Depressive disorders in ICD-9-CM

NEC : Not elsewhere classified, ICD : Internal Classification of Diseases

Table 16
Depressive disorders in ICD-10


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