Monday, August 27, 2007
Are Too Many People Being Diagnosed with Depression?
You can't open a medical journal or medical news without reading another article about how to screen patients for depression and prescribe antidepressants. The British Medical Journal has explored this in a "Head to Head" article where over diagnosis and under diagnosis of depression were debated.
On the Yes side is Dr. Gordon Parker who argues that feeling depressed is normal and that 95% of teachers studied, experienced feeling low mood and they met the "diagnostic" criteria for major, minor or sub depression. He believes the descriptive criteria for depression in the DSM-III (the bible of psychiatric diagnosis) is set too low and it medicalizes "normal human distress as mandating treatment." "Depression will remain a nonspecific catch-all diagnosis until common sense prevails," Dr. Parker says.
On the No side is Dr. Ian Hickie who counters that depression is not being overdiagnosed because increased treatment has led to demonstrable benefits and is cost effective. He believes the promotion of safer antidepressant drugs during the 1990s awakened broader interest in depression and the increased rate of diagnosis led to improved physical health, and abandonment of "demeaning labels of stress, nervous breakdown and adolescent angst."
I believe depression is over diagnosed. Stress, anxiety and sadness are normal human emotions and in our fast paced world we don't tolerate these feelings very well. People want and expect a quick fix when they feel bad. The antidepressants Paxil and Lexapro are the top two prescribed drugs in the US. Four antidepressants are in the top 15 prescribed drugs. (Paxil, Zoloft, Lexapro and Effexor). That is a lot of depressed people! There is a huge push by the pharmaceutical industry, the government (yes, the government) and the insurance companies for primary care physicians to quickly diagnose AND TREAT depression.
Depression is a serious disease and we are blessed to have good treatments but that many people do not need drugs.
Posted by Toni Brayer, MD at 9:41 PM