No, no, all good reading....

I had considered the need for some sort of physician consultation when considering clients who may want to "tough it out" with, like you described, CBT type therapy. I also employ DBT therapy, as I feel it gives a person an increased level of intentionality in their life. My intention is not to recommend someone discontinue their antidepressants, but to offer a therapeutic approach for those clients who want to make a go of it without medication. Obviously one requirement would be that they are not suicidal, or have been recently, but I do believe there are people that can and want to do it without medication.

What I am seeing is a lot of people being diagnosed, after a two hour interview, as major depressive disorder, and, IMHO, too frequently, bipolar. I think there needs to be more discussion on the differential diagnosing of these disorder, especially with bipolar, as there are a number of disorders that present with symptoms similar to bipolar but that are qualitatively different in many ways. A client's initial diagnosis is based on a two hour subjective interview, based pretty much on what the client reports on himself, and absent of any testing.

How are you distinguishing between severe and moderate depression? (the distinction between severe and mild is obvious, but more obscure sometimes is the distinction between mild depression and dysthymia). I've tried going to the university library and looking for journal articles on the problem of accurate diagnosis with not great results. (I get a lot of interesting looking abstracts but come across very little that addresses the questions I'm trying to answer. ) (am I using the wrong key words or phrases?)

Input's greatly appreciated.