questionQ. When diagnosing depression in a client, how concerned should I be about identifying specific depression subtypes? Do specific subtypes suggest different treatment modalities?

A. For years now, clinicians have attempted to categorize depressions into “subtypes.” A few examples are: typical vs. atypical, reactive vs. biological and psychotic vs. non-psychotic. There are as many as 12 subtypes of Major Depressive Disorder, according to The Diagnostic and Statistical Manual, 4th Edition (DSM-IV).

The important question though is whether labeling a depression by subtype assists the clinician in treating the client more effectively, or whether diagnosing a specific subtype implies that a different treatment modality should be utilized. With few exceptions, the answer is no.

Subtypes generally are poor predictors of treatment response. There are some exceptions however: Seasonal Affective Disorder, for example, may respond to light therapy as well as antidepressants, and psychotic depressions all but always require antidepressant treatment augmented with antipsychotics.

Don’t be overly concerned about subtypes. Pigeonholing depression is short-sighted and undermines what’s most important: Treating the “whole” patient from a bio-psycho-social perspective.