Introduction to assessment in depression

Abstract

The diagnosis of depression has been revised over the past decade in accordance with the International Statistical Classification (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnostic criteria [1, 2]. While these publications give a framework for the classification of mental disorders, there is also a necessity for a multidimensional approach, which can be obtained by using assessment scales for syndromes across different psychiatric categories. It is worth noting that these scales cannot be used for establishing diagnosis but are helpful for grading the severity of the condition irrespective of the diagnostic category, as well as enabling treatment plans for psychopharmacological and psychotherapeutic methods. Different psychometric rating scales have been used for evaluating psychotropic agents within and across diagnostic categories. Although this indicates the validity of the scales used, it does not mean that they are necessarily the most sensitive scales for certain indications. One example is the Hamilton Depression Rating Scale for Depression (HAM-D), which can overemphasize sedative antidepressants because there are three items for sleep disturbances (in contrast to the Montgomery-Asberg Rating Scale for Depression [MADRS] with only one item relating to sleep parameters) [3, 4]. It should be emphasized that many rating scales do not adequately reflect our current understanding of the phenomenology of the disorders (e.g., male depression with higher levels of aggression), which may change as continued research leads to the discovery of new neurobiological entities.