• DOI:10.1111/j.1600-0447.2007.00956.x
• Corpus ID: 221452354

Preface

@article{Bolwig2007Preface,
  title={Preface},
  author={Tom Gert Bolwig and Edward Shorter},
  journal={Acta Psychiatrica Scandinavica},
  year={2007},
  volume={115}
}

• T. Bolwig, E. Shorter
• Published 1 February 2007
• Psychology
• Acta Psychiatrica Scandinavica

There has been rising unhappiness within psychiatry and psychopharmacology over the heterogeneous nature of major depression, over the poverty of current patent-protected offerings in the treatment of mood disorders, and over the lack of innovative new approaches in drug discovery. In May 2006 a group of specialists in the biology, history and clinical care of mood disorders met in Copenhagen to consider one of the principal illness entities within the category major depression – melancholia. The point of the conference was to identify new directions in the biological understanding and clinical care of melancholic illness, a robust historical diagnosis that now seems ripe for revival. The organizers were Tom G. Bolwig, professor of psychiatry in Copenhagen, Max Fink, professor of psychiatry at the State University of New York Stony Brook Campus, Gordon Parker, professor of psychiatry at the University of New South Wales in Sydney, and Edward Shorter, professor of psychiatry and medical history at the University of Toronto. The 14 other participants came from many parts of the globe. While it would be unrealistic to talk about a consensus in this diverse body of scholars, a kind of majoritarian sentiment did emerge from the conference. This commonality of feeling touched several issues – the need to break up major depression into natural underlying illness entities. The present science does not permit a definitive carving of nature at the joints here. But at a minimum major depression should be broken into melancholic mood disorder (MMD) and nonmelancholic mood disorder (NMMD). Melancholia represents a disease in itself on the basis of psychopathology, biology, and response to treatment. MMD is characterized clinically by psychomotor change and symptoms of severe mood disturbance; biologically, it demonstrates distinctive neuroimaging features, a characteristic response to the dexamethasone suppression test, and shows rapid eye movement sleep latency; in therapeutic terms, melancholia responds preferentially to electroconvulsive therapy and to certain psychopharmacologic approaches. Non-melancholic mood disorder, by contrast, demonstrates few of these characteristics and represents a mixture of anxiety, character disturbance, and situational reactions that requires further elucidation. While not ignoring a half century of progress in research into neurotransmitters, there was a sentiment at the conference that other biological mechanisms, particularly those involving the endocrine system, need to be investigated. Historically, endocrine research constituted one of the first incursions of biological thinking into psychiatry. The diagnosis of melancholia invites a revival of neuroendocrine approaches to psychiatry today. We have included much of the conference discussion here so that readers will be able to judge for themselves the liveliness of the give-andtake about these points. Far from being a consensus conference, the Copenhagen meeting represented forward-looking thinking in the psychopathology of mood disorders, in the dismantling of received wisdom about major depression, and in a convergence of the clinic and the bench that, one hopes, will result in better patient care. Because the conference had the overall character of a discussion based on scholarly papers, many of them discussions in themselves, the editor of the Acta Psychiatrica Scandinavica has kindly exempted the proceedings from the journal’s customary rules for the structuring of manuscripts. Finally, we thank Lundbeck Company for generously sponsoring the conference and the present publication with an unconditional educational grant.