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Review
. 2014 Mar;59(3):148-51.
doi: 10.1177/070674371405900306.

The mistreatment of major depressive disorder

Joel Paris
Review

The mistreatment of major depressive disorder

Joel Paris. Can J Psychiatry. 2014 Mar.

Abstract
in English, French

Objective: To examine the effects of classification on treatment in major depressive disorder (MDD).

Method: This is a narrative review.

Results: MDD is a highly heterogeneous category, leading to problems in classification and in specificity of treatment. Current models classify all depressions within a single category. However, the construct of MDD obscures important differences between severe disorders that require pharmacotherapy, and mild-to-moderate disorders that can respond to psychotherapy or remit spontaneously. Patients with mild-to-moderate MDD are being treated with routine or overly aggressive pharmacotherapy.

Conclusions: The current classification fails to address the heterogeneity of depression, leading to mistreatment.

Objectif :: Examiner les effets de la classification sur le traitement du trouble dépressif majeur (TDM).

Méthode :: Il s’agit d’une revue narrative.

Résultats :: Le TDM est une catégorie hautement hétérogène, ce qui entraîne des problèmes pour la classification et la spécificité du traitement. Les modèles actuels classent toutes les dépressions dans une seule catégorie. Toutefois, le construct du TDM occulte d’importantes différences entre les troubles graves qui demandent une pharmacothérapie, et les troubles bénins à modérés qui peuvent répondre à la psychothérapie ou se rétablir spontanément. Les patients souffrant d’un TDM bénin à modéré sont traités avec la pharmacothérapie courante ou trop vigoureuse.

Conclusions :: La classification actuelle ne tient pas compte de l’hétérogénéité de la dépression, ce qui entraîne un traitement fautif.

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