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—Dr Mattes' letter clearly indicates that controversy remains regarding the boundaries of "major depression." It is not true that in developing the DSM-III criteria for MDE there was no attempt to "limit excessive diagnosis." In fact, we recognized that the RDC symptom criteria were sometimes incorrectly considered to have been met even when they did not persist together for at least two weeks. Therefore, in DSM-III, each symptom must be present "nearly every day for a period of at least two weeks." This ensures that the diagnosis of major depression is only given when a full affective syndrome is present—a requirement not made in the DSM-II categories of depressive neurosis or adjustment reaction.
We certainly agree with Dr Mattes that the DSM-III subtype of melancholia is an important one that identifies a group of persons who are relatively homogeneous with respect to "biology, etiology, family history, [and] treatment response." However,
Spitzer RL, Williams JBW. DSM-III Criteria for Major Depressive Episode-Reply. Arch Gen Psychiatry. 1981;38(9):1069. doi:10.1001/archpsyc.1981.01780340121019