Persistent Depressive Disorder: Commentary on Parker andMalhi

摘要

In their recent Perspective article, Parker and Malhi1 provide an impassioned critique of the Diagnostic and Statistical Manual of MentalDisorders, 5th edition (DSM-5) diagnosis of persistent depressive disorder (PDD). They arguethat the diagnosis should be abolished, as it lacks a rationale and supporting evidence forcombining chronic major depressive disorder and dysthymic disorder in a separate category.They also contend that PDD includes many cases that do not have a clinically significantdisorder and that the diagnosis may be better conceptualized as a reflection of personalitydisturbance than as a mood disorder. They conclude by advocating that the diagnosis besubsumed as a chronic course modifier within a unitary depressive disorder category. However,Parker and Malhi overlook most of the evidence that led to establishing the PDD diagnosis. Inthis Commentary, I will summarize the rationale and evidence for PDD,beginning with some historical context, and will then briefly address some of Parker andMalhi’s other points.