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             Many of the conditions and disorders described by the DSM IV are defined by subjective symptoms, and Mood Disorders, including Major Depressive Disorder, are certainly among these.  Mood Disorders are, at the same time, among the most commonly diagnosed and treated conditions in the United States.  Among the criteria evaluated for a diagnosis of depression are depressed mood for most of the day, markedly diminished interest or pleasure in activities, particularly in normally enjoyable activities and feelings of worthlessness.  Not only are all of these criteria subjective to a certain extent, but all are also relative.  No two people are the same and if there is such a thing as a normal mental and emotional state for an individual it is certainly unique to that individual.  Individuals are also certainly not emotionally constant; everyone has ups and downs emotionally, and circumstance can potentially make what might ordinarily be abnormal behavior or thought into a very reasonable in other circumstances. 

The example that I’ve always been given is that the symptoms of agoraphobia may manifest in people living in a war zone, but because those individuals are legitimately afraid to leave their homes, and it is reasonable to say that those people are not disordered.  A similar issue that often arises when discussing mood disorders and MDD in particular is grieving and the distinction between normal sadness in response to a serious loss and depression.  The DSM does attempt to take into account normal grieving in its criteria for the diagnosis of MDD, precluding anyone from receiving a MDD diagnosis within three months of a major traumatic event, which is probably better than not including any provision, but still problematic because there isn’t necessarily a compelling reason why a proper period of mourning should end after three months, or have any set period.  Criteria for depression can also be adjusted based upon the age of the patient.  Depression in young children, particularly young boys, is often characterized by irritation and anger rather than sadness; and arguments have been made that ADHD is underdiagnosed in young girls because they tend to be inattentive without being hyperactive.  Disorders can include very different and sometimes almost opposite or contradictory symptoms that it is easy to wonder whether the distinctions made between disorders or the symptoms swept up into a disorder are based upon any real sameness of the source of those symptoms.  Of course this becomes a very significant question when dealing with treatment; if you proceed with the assumption that ADHD and Depression should be treated with the appropriate medications it becomes very hard to know how to proceed when faced with a patient with the symptoms of any number of disorders.  Is an angry disruptive boy depressed, hyperactive, does he have a conduct disorder?  Combine that with the inconsistent effectiveness of different medications and often treatment succeeds via trial and error when it does.