Major depressive disorder: From accurate diagnosis to effective treatment through first-person psychopharmacology

This article critically examines the diagnostic criteria for Major Depressive Disorder as presented in the DSM-5-TR, with a particular focus on the symptoms of ‘depressed mood’ and ‘psychomotor agitation or retardation’. While existing literature in both humanistic psychology and phenomenological psychopathology has highlighted the limitations of the Diagnostic and Statistical Manual of Mental Disorders (DSM) symptom-based and externalist model, this article contributes to the discussion by grounding its critique in first-person accounts and by analysing how the aforementioned symptoms, as conceptualised in the DSM, flatten and obscure the lived experience of depression. It argues that the symptom of ‘depressed mood’ is conceptually circular and diagnostically imprecise, while ‘psychomotor agitation or retardation’, insofar as it is diagnosed based on being ‘observable by others’, fails to capture the phenomenological nuances of the experience, such as the loss of volition. Such limitations point to the need for an approach that takes seriously the lived, first-person dimensions of depression, rather than reducing the experience to externally verifiable signs. In this regard, by advancing a symptom-specific critique grounded in phenomenology, this article calls for a more person-centred approach to psychiatric diagnosis, one that considers the role of first-person experience. Finally, this article reflects on the implications of a person-centred approach for the evaluation of psychotropic medication, especially with regard to experiential phenomena such as depersonalisation and derealisation.