The Mistreatment of Major Depressive Disorder

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.