title: Targeting and transforming major depression.
abstract: OBJECTIVE
  To detail limitations to the construct of 'major depression', argue for repositioning it as a proxy for 'clinical depression' and then operationalize it and its principal constituent depressive subtypes, while preserving the DSM criteria-based format.
  
  
  METHODS
  We summarize limitations to major depression being viewed as a diagnostic entity. Data from 391 clinically depressed patients were analysed to identify high-prevalence non-specific depressive symptoms to define 'clinical depression' as well as the features showing specificity to a melancholic depressive subtype.
  
  
  RESULTS
  We identified a set of high-prevalence and generalized symptoms for defining clinical depression and with many being current criteria for major depression. We also developed a refined set of melancholic features and with their underlying distributions generating two classes that correlated strongly with clinical diagnoses of a melancholic or non-melancholic depression, thus validating its capacity to so differentiate. We append criteria sets for diagnosing clinical depression and its principal diagnostic subtypes (psychotic, melancholic and non-melancholic).
  
  
  CONCLUSIONS
  This heuristic study reframes and modifies major depression's criteria set to define a domain of clinical depression with additional criteria and then allowing the delineation of three diagnostic subtypes. If this paradigm shift is accepted and further refined, greater precision in diagnosis, treatment and research would be anticipated.
authors.affiliation: School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.|The Black Dog Institute, Sydney, NSW, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Parker
authors.affiliation: School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.|The Black Dog Institute, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Paterson
authors.affiliation: School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.|The Black Dog Institute, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: McCraw
authors.affiliation: School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.|The Black Dog Institute, Sydney, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Hadzi-Pavlovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
keywords: classification; depression; diagnosis