The Digital Conceptualisation of Depression – Dr Arshya Vahabzadeh

Posted on February 3, 2017

Dr Arshya Vahabzadeh, Harvard-trained physician-technologist and innovation officer of the Massachusetts General Psychiatry Academy talking about the complexity and heterogeneity of depression when broken down into its symptom components.

Key Messages:

Depression is a collection of symptoms.

The big question is – How many different symptom combinations can lead to the diagnosis of depression?

227 symptom combinations can lead to a Major Depression Diagnosis

This means that people with depression do not look the same.

Furthermore, there is tremendous overlap with other psychiatric disorders indicating that the categories in DSM are by no means ‘clean categories’

For example following is the prevalence of respective conditions in depression

  • Alcohol abuse/dependence = 27%
  • Anxiety disorders = 57%
  • Personality disorders = 44%
  • Pure MDD = 21%

To add to the complexity we know that the microbiome, the gut and the brain are all linked and the inflammatory hypothesis of depression creates further heterogeneity.

Thus; Is it time to reimagine our research scales?

What do our research scales actually show?

An interesting study by Eiko Fried investigated to which degree 7 common depression scales differ in their item content and generalisability. The 7 instruments encompass 52 disparate symptoms. Surprisingly, 40% of the symptoms appear in only a single scale, and 12% across all instruments.

The author concludes –

The substantial heterogeneity of the depressive syndrome and low overlap among scales may lead to research results idiosyncratic to particular scales used, posing a threat to the replicability and generalizability of depression research.

One has to ask –

What on earth are we measuring?

Not each patient weighs each symptom equally – How each symptom matters to a patient varies a great deal.

What are the things that are going to give our patients the best quality of life?

Perhaps the most striking statistic of all is that only 28.7% receive any treatment for depression.

Reference:

Fried, E. I. (2017). The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. Journal of Affective Disorders, 208, 191-197.