Diagnosing depression--looking backward into the future.

Before the advent of antidepressants, no generally accepted and operationalized classification of depression existed. In the late fifties and sixties we developed a multi-axial and operationalized depression taxonomy in order to be able to study systematically the clinical and biochemical action of antidepressants and biological characteristics of depressives responsive to antidepressants. The keypoints of that system and the data on which it was based are discussed, after which it is compared with the depression classification proposed by the DSM III and DSM III-R. Though it is recognized that a system based on consensus opinion can never be overall acceptable to everyone, the conclusion is reached that the DSM depression classification is outright unsatisfactory and contributes to diagnostic confusion rather than to reduce it. It is recommended that an immediate moratorium should be laid on expert-opinion-based alterations in the classification of depressions and that future changes will be based only on research specifically designed to resolve issues pertinent to that classification. In organizing, conducting and funding such a collaborative, goal-directed effort, the National Institute of Mental Health could play a seminal role.