Two Diagnostic Traditions: Kraepelin & Spitzer’s DSM Tradition Versus the Treatment Resistant Depression Literature Tradition

Abstract Objective To review the evolution of the DSM diagnostic tradition and compare the diagnostic traditions of DSM-III through DSM-5 to a 35-article sample taken from the Treatment Resistant Depression (TRD) diagnostic literature. The major conclusion drawn is that the TRD diagnostic literature is seriously flawed due to a design error that renders the literature uninterpretable. Finally, to counter the design error and answer the implicit question that the TRD literature raises, we recommend three alternative strategies to answer the question: What are the best treatments for the DSM-5 unipolar mood disorders? Methods The paper is a Review Paper comparing the DSM diagnostic tradition with the diagnostic tradition in the TRD literature. We propose three alternative recommendations to the flawed TRD tradition that addresses the issue of treatment efficacy for the DSM-5 unipolar mood disorders. Results We respond to the design limitations of the TRD diagnostic literature and propose alternative approaches to the treatment non-response issue. Conclusions We offer a viable alternative to TRD’s diagnostic concern with non-response when it comes to the DSM-5 unipolar mood disorders.