during their lifetime in epidemiological studies using current criteria [4] . It is unlikely that a syndrome as polymorphic and widely diagnosed as major depressive disorder (MDD) will reflect a single process. Attempts to delineate different forms of depression by statistically analyzing the symptomatology of large samples of patients without taking into consideration life events or childhood history have been unsuccessful. It may be necessary to consider childhood trauma, marital and employment stress, and medical health in diagnosing subtypes of depression. Epidemiologic data on the effects of childhood trauma, unemployment and divorce on depression incidence are strong [5, 6] . DSM-IV does make one allowance for circumstances by including a bereavement exclusion [7] . However, it seems that bereavement is not different from other losses and stresses that are associated with depression [8] . The pharmacotherapy of depression offers a plethora of medications. However, depression is often resistant to standard antidepressant medication, and a large percentage of patients respond just as well to placebo [9, 10] . The DSM broad diagnosis of MDD does not encourage a search for subtypes of depression that may require specific treatment. The current diagnostic system may be partly responsible for the rising placebo response rates and increasing numbers of subjects required to demonstrate efficacy in ever larger clinical trials. Introduction