From the point of view of exact diagnosis perhaps no psychiatric condition is as unsatisfactory as depression. It can be a symptom or a diagnosis. It is recognized as a normal mood. There is even considerable variation in the diagnostic use of the term. The diagnoses manic-depressive psychosis, involutional depression, reactive depression, neurotic depression, etc., are still widely used, even though they no longer have official standing. To add to the semantic confusion, it must be admitted that the diagnosis of depression in psychiatry is still largely impressionistic and lacks precision. The psychiatrist bases his clinical opinion on a careful evaluation of the history, the complaints, the appearance of the patient, the course under observation or treatment, psychological tests, and intuition.
As bad as this state of affairs is, the diagnosis of suicide risk is even worse. Here even educated guessing it notoriously fallible,