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.


Rich said...

This is a very interesting topic. What may cause “situational depression” in some people cannot compare to real clinical depression. It’s tough to sort out sometimes without psychotherapy. I believe that talk therapy is a very useful tool in helping people who feel down or depressed. Too many people just want to take a magic pill and be cured. This only leaves people feeling worse when it does not do just that.

Anonymous said...

Current Depression Medications: Are Drugs Such As SSRIs More Beneficial Than Deadly For the Patients?

Presently, for the treatment of depression and other what some claim are other types of mental disorders, as some claim certain mental disorders are somewhat questionable, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice by most prescribers today. Such meds, meds that affect the mind are called psychotropic medications. SSRIs also include a few meds in this class with the addition of a norepinephrine uptake inhibitor added to the SSRI, and these are referred to SNRI medications, which combined with SSRIs, are the number 1 top therapeutic class of prescriptions presently. While there are several available SSRIs presently, two SNRIs available are Cymbalta and Effexor. Some consider these classes of meds a next generation mood enhancer after the benzodiazepine hype decades ago, as there are similarities regarding their intake by others, yet the mechanisms of action are clearly different, but not their continued use by others. Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence. In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.
And depression is only one of those mood disorders that may exist in certain patients, yet possibly the most devastating one. An accurate diagnosis of these mood conditions lack complete accuracy, as they can only be defined conceptually, so the diagnosis or impression concluded by the patient’s doctor is dependent on subjective criteria, such as questionnaires and patient observation. A social patient history is uncertain and tricky as well, some have said. There is no objective diagnostic testing for depression. Yet the diagnosis of depression in patients has increased quite a bit over the past few decades. Also, few would argue that depression does not exist in other people to the degree that the affected patient believes their mental condition is presently. Yet, one may contemplate, actually how many people are really depressed? What is believed is that if one is disabled or impaired from a mental paradigm, treatment is necessary and appropriate with medication.
In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems.
Several decades ago, less than 1 percent of the U.S. population were diagnosed with depression, some have said. Today, it is believed that about 10 percent of the total population in the United States have or have experienced depression at some time in their lives that may vary in severity and longevity. Why this great increase in the growth of this condition remains unknown and is subject to speculation.
What is known is that the psychiatry specialty is the one specialty most paid to by certain pharmaceutical companies for ultimately and eventual support of their psychotropic meds that they currently promote to these doctors, as this aspect of the pharmaceutical industry clearly desires market growth of these products.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders are suspected by a health care provider. Yet these meds discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected disease states.
Over 30 million scripts of these types of meds are written annually, and the franchise is around 20 billion dollars a year now, along with some of the meds costing over 3 dollars per tablet. There are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause. The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received upon request of their manufacturers additional indications besides depression for some really questionable conditions, such as social phobia and premenstrual syndrome. With the latter, I find it hard to believe that a natural female experience can be considered a treatable disease. Social phobia is a personality trait, in my opinion, which has been called shyness or perhaps a term coined by Dr. Carl Jung, which is introversion, so this probably should not be labeled a treatable disease as well. There are other indications for certain behavioral manifestations as well with the different SSRIs or SRNIs. So the market continues to grow with these meds. Yet, it is believed that these meds are effective in only about half of those who take them, so they are not going to be beneficial for those suspected of having certain medical illnesses treated by such meds. The makers of such meds seemed to have created such conditions besides depression for additional utilization of these types of medications, which is a process known as disease mongering. Drug companies that make these medications are active and have been active in forming mutual relationships with related disease- specific support groups, such as providing financial support for screenings for the indicated conditions of their meds- which includes the screening of children and adolescents in particular, I understand. As a layperson, I consider such activities dangerous and inappropriate for several reasons.
Danger and concerns by others with these psychotropics primarily involves the adverse effects associated with these types of meds, which include suicidal thoughts and actions, violence, including acts of homicide, and aggression, among others, and the makers of such drugs are suspected to have known about these effects and did not share them with the public in a timely and critical manner. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others, such as those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, including the decreased efficacy of SSRIs in general, which is believed to be less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall. Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them. For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect could cause harm rather than benefit? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist. It is observed in some who take such meds, but not all who take these meds. Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994.
Finally, if SSRIs or SNRIs are discontinued by a patient without medical supervision, withdrawals are believed to be quite brutal, and may be a catalyst for suicide in itself, as not only are these meds habit forming, but discontinuing these meds abruptly, I understand, leaves the brain in a state of neurochemical instability, as the neurons are recalibrating upon discontinuation of the SSRI or SNRI that altered the brain of the consumer of this type of med. This occurs to some degree with any psychotropic med, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed.
SSRIs and SRNIs have been claimed by doctors and patients to be extremely beneficial for the patient’s well -being regarding the patient’s mental issues where these types of meds are used, yet the risk factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug. Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants, in a similar manner some time ago. Considering the lack of efficacy that has been demonstrated objectively with the newer psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other treatment options should probably be considered, but that is up to the discretion of the prescriber.
It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken in the past, for example. Because at times, a doctor can in fact do harm without intent.
“I use to care, but now I take a pill for that.” --- Author unknown
Dan Abshear
Author’s note: What has been written is based upon information and belief

Anonymous said...

People are often caught by depression unawares. It is also one of the most common diseases amongst the human society. Another very tricky issue with depression is the difficulty in diagnosis. Many a time depression cannot be diagnosed in the correct time. However, now there is some hope as doctors might have invented a test to diagnose depression. Once it is diagnosed it can be treated by any of the depression cures. The following link also talks about depression cure.

Shu said...

Went to an all night party and friends were passing around a euphoric enhancer to help us stay in the mood and party all night into the wee hours of the morning. And that it did! I tried other mood enhancers but they were not very effective. Trip2night is a great euphoric enhancer and worked wonders for me. It comes in a powdered form and mixes easily.

viagra online said...

many?? a lot I think so! I knoe that in the world many people with Depression live in normal style, I have been reading about it
Depressed mood is a normal reaction to certain life events, a symptom of many medical conditions (e.g., Addison's disease, hypothyroidism), and a feature of certain psychiatric syndromes.
and I have the opinion that this can be for the reason of the crazy lifestyle that the people have !

viagra online said...

We've all heard of it. Most of us will come into contact with it at some point in our lives. Depression is a difficult and miserable experience to go through, and it's something that either you or someone you love will have to deal with. However, it isn't just the victims who are impacted. What about their friends? said...

This cannot have effect in actual fact, that's what I think.

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