Clinical Research in Depression

Despite impressive advances in research and therapy, our theories of clinical depression remain rooted in 19th-century concepts derived from experiences with hospitalized and psychotic patients. Current clinical experience, however, is mainly with nonpsychotic and noninstitutionalized patients. Unresolved problems include: the role of life experience in depression, delineation of psychopathologic states from normal emotional reactions, classifications and differentiation of types of depression, the need for better predictors of treatment response, and social and clinical criteria for outcome studies. These issues will be discussed within the framework of an adaptational approach which attempts to bridge recent developments in neuropharmacology, therapeutics, and clinical research.