Depression: How 'Staged' Approach Could Aid Diagnosis & Therapy

A woman looks at her phone, sadly.
(Image credit: lzf/

People with symptoms of depression are currently lumped into just two categories: Either they have clinical depression, or they don't. But instead, a "staged" approach to diagnosing depression — one that makes room for having different degrees of symptoms — could improve the way people are diagnosed and treated, according to a new editorial.

This staged model would involve looking at depression along a continuum, from wellness, to temporary distress, to an actual depressive disorder, according to the editorial.

If this model was used, then a fairly large proportion of people who are currently diagnosed as having depression probably would not get the "disorder" diagnosis, said the author of the editorial, Dr. Vikram Patel, a psychiatrist and researcher at the Harvard Medical School in Boston. [7 Ways Depression Differs in Men and Women]

Mental health is a complex phenomenon that is rooted in people's diverse experiences, and the current system is too simplistic for this reality, Patel wrote in his editorial, published Monday (April 4) in the journal PLOS Medicine.

Other researchers have criticized the binary approach, saying it may lead doctors to treat certain typical human reactions to loss or adversity as a medical problem that requires treatment, according to the editorial. For example, when a person who has experienced the death of a loved one is diagnosed with depression, a doctor may choose to treat that person with antidepressants. However, treating a person who is having a normal human reaction with a nondrug option, such as an internet-based program, could be more appropriate and effective, according to the editorial.

In Patel's classification system, people with no distressing experiences would be considered "well." Those who had experienced upsetting feelings for less than two weeks would be considered "distressed." People who had severely distressing experiences, which last from two weeks to a month, and which affect a person's social functioning, would be diagnosed with a depressive disorder. People would be diagnosed with "recurrent or refractory depressive episodes" if they had severe, recurrent depressive episodes, or if their depression wasn't helped by existing treatments.

Each of the last three categories could then be addressed with a different type of treatment ranging from digital interventions to antidepressants and other medications, according to the editorial.[8 Tips for Dealing with a Depressed Spouse]

Dr. Tina J. Walch, a psychiatrist and medical director at South Oaks Hospital in Amityville, New York, who was not involved with the new editorial, said the paradigm shift that Patel is suggesting could pave the way "for a more generalized acceptance and understanding of behavioral health issues."

"More people may be able to relate" to the less severe forms of the illness, she said. And the more people who relate, the more they may be willing to discuss the symptoms and life impact of depression. This could lessen the stigma associated with depression "for everyone, across the entire spectrum," she said.

Originally published on Live Science.

Staff Writer