Posted by SLS on December 14, 2009, at 21:11:22
In reply to Re: Atypical Depression versus Bipolar Depression, posted by bleauberry on December 14, 2009, at 18:01:39
Diagnosis and categorization is critically important in identifying an illness so that an effective treatment can be effected. This is as true in the pursuit of healing in mental illness as it is in other illnesses. I don't think we should abandon this paradigm in building an approach toward treating depression more efficiently. We as humans become frustrated when our attempts at categorization and decision-making fail to provide the desired result. That does not mean that it is pointless to attempt to pusue the goal. Up until recently, empirical observation of behaviors has been the only tool we had available for trying to understand and treat mental illness. Although we are on the brink of being able to provide more exacting methods of diagnosis, it will be a few years yet before what emerges in the laboratory becomes available in the field. In the meantime, you use what you have. The description of illness presentation and treatment outcome is a valid tool to move us beyond blind trial-and-error. I don't think it is wise to throw away the principle of diagnosis just because we don't have it right yet. We simply need more information and understanding.
I do not believe that is productive to condemn everything for the sake of nothing. It would be more productive to offer suggestions of what can be done rather than to limit one's preoccupations to that which cannot. Refining and validating the descriptions of illness based upon clinical observation and psychometric testing is a good place to start when biological markers are unavailable.
If one could isolate a behavioral difference that would effectively differentiate between bipolar disorder and ADD, wouldn't it be humane to do so in order to choose an effective treatment? So, if the presence or absence of mood reactivity can help a physician choose between the use or non-use of lithium in a case of depression, wouldn't that also be humane? When the genomic differences between bipolar and unipolar depression are elucidated and measurable, will it not be humane to use that information to substantiate diagnosis and determine treatment algorithms?
What is inherently wrong with trying to get it right? I guess we are all doing the best that we can with what we have to work with. This is as true for the doctors as it is for the patients.
> DX terminology, I feel, is interesting but really doesn't serve a respectable clinical purpose.
I disagree.
If a doctor were to determine that a person complaining of depression were presenting with a TSH of 10.0 and elevated lymphocytes, would it be an irresponsible decision on his part to render a diagnosis of Hashimoto's Thyroiditis so that he could choose appropriate treatment? What is so flawed at its core about the concept of diagnosis?
- Scott
poster:SLS
thread:929182
URL: http://www.dr-bob.org/babble/20091206/msgs/929274.html