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D Summerfield (March 2006 JRSM1) reports that we are in a pseudo-epidemic of depression. He says that this is mainly because, with our Western classifications, we have medicalized misery and are treating it as a pathological entity with our prescriptions for antidepressants—to the benefit of the pharmaceutical industry.
Although this may be partly true, it is important to mention that our classifications change with emerging novel evidence. In fact, the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project has been set up to address nosological issues and improve the clinical utility of the concept of major depressive disorder (MDD).2 Also, a long-term prospective, naturalistic study of depressive symptoms in MDD showed a generally fluctuating mood state with minor and subsyndromal levels alternating with the MDD syndrome in the same patients, suggestive of an illness on a continuum.3 Furthermore, a recent well-conducted placebo-controlled study has shown fluoxetine to have efficacy in the treatment of minor depression.4
One must not ignore the role of culture and the individual patient's narrative. However, neither can we ignore the evidence for the role of biology in depression, in particular the efficacy of antidepressants in relapse prevention.5
Competing interests None declared.