Changes needed in the classification of depressive disorders: options for ICD-11

Abstract

This paper considers changes required to the classification of non-bipolar depressive disorders in ICD-11, using ICD-10 as a starting point. The new classification needs to recognize recent epidemiological findings, cross-cultural variations in presentation of depression and differences in provision of health care among WHO Member States. Recommended changes in organization include making the main distinction between bipolar and unipolar disorders, and use of only one overall depressive episode diagnosis, with the distinction between first and recurrent episode to become a subtype or be abandoned. Some redrafting of the criteria for depressive episode is suggested, in order to simplify. Subtypes are discussed, with possible addition of two subtypes (seasonal affective disorder and postpartum depression) and an improved way of handling mixed anxiety-depressive disorders.