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Is depression overdiagnosed in today's society?
Yes, says Professor Gordon Parker in the August 18 2007 issue of the British Medical Journal.
Rates of diagnosis of depression have risen steeply in recent years. Parker, a scientia professor from the School of Psychiatry, University of New South Wales, believes this is because current criteria for diagnosis are medicalising emotions (like sadness) rather than true clinical depression.
| | Reasons for the overdiagnosis include lack of a reliable and valid diagnostic model and marketing of treatments beyond their true utility in a climate of heightened expectations. |
But does it really matter if people are being overdiagnosed with depression?
After all, implies the article, having a low diagnostic threshold for depression encourages people to seek help, it allows them to get a clinical assessment and it helps to destigmatise the condition.
Well, here again Professor Parker believes that yes, it matters. He compares these false positives of depression diagnosis to false positives of breast cancer detection.
| | Breast screening programmes may lead to detecting more malignant lumps. However, false positive results generated by breast screening are filtered out by refined assessment, and harm rarely occurs. [However,] for false positive detection of depression, many of psychiatry's leaders mandate treatment, which for many with less severe conditions raises hopes but results in a sequence of ineffective and inappropriate treatments. |
He implies that treatment of subclinical depression may do more harm than good in some cases and that the benefits of treating minor and subsyndromal depressions are still unclear.
Professor Parker acknowledges that there may remain a lot of undiagnosed depression cases but argues this does not mean that depression is underdiagnosed. There are still too many people being overdiagnosed, he says.
Image from The JAMA Patient Page.
Comments
The thing is, even if you're misdiagnosed as depressed when really you're just sad or in mourning or whatever, any pharmaceuticals prescribed won't do an ounce of good unless the person really is depressed.
And talking therapies can be beneficial for anyone, not just people with serious mental illness.
It seems to me the real threat of overdiagnosis of depression is monetary and statistical more than anything else.
Posted by: Jon S. | August 25, 2007 1:51 PM
hrm, i thought that part of the diagnosis of depression is that it endures for a period of time .. and it has a distinct cause that the sufferer can point to (a death or other loss), whereas depression is often causeless and persistent over the years. am i wrong?
Posted by: "GrrlScientist" | August 25, 2007 4:44 PM
You are right. Depression, like all borderline personality disorders, must last for a long period of time, more than 6-12 months. Clinical depression often causes serious problems in daily activities. Atypical depression is more common and it is bordering on everyday sadness and serious problem.
I believe that most of the diagnosis are prescribed because someone must consume those drugs. Not a conspiracy, but not far either.
Posted by: Toni Petrina | August 25, 2007 8:07 PM
There's a dynamic causing people to seek a depression diagnosis as well, to some extent. You're feeling sad and lonely because your social life has collapsed, because your marriage or career has failed or any number of (perfectly normal) adverse social events. But for many people that implicitly means you're a loser; it's perceived as being your fault. If you get a depression diagnosis, it's suddenly no longer a problem with you. Perversely, the diagnosis itself - even if in error - tells you that "it's not you - you're OK, really". Which of course can help somebody who's down (but not depressed) a lot even if the prescribed medication does not.
Posted by: Janne | August 25, 2007 9:42 PM
No nosological taxonomy that I've ever heard of contains a class of disorders called "borderline personality disorders." The DSM-IV does recognize a borderline personality disorder, which is quite distinct from depression.
Posted by: kjupi | August 25, 2007 9:52 PM
Depression is not a personality disorder, and personality disorder itself is a very dubious diagnostic category which should be dumped from the lexicon.
And, yes, we are almost certainly way overdiagnosing, and often overtreating, depression. It is an inevitable outcome of the combination of high pressure advocacy (by a whole range of interests), and inherently highly subjective, definition based, diagnostic criteria that cannot be properly falsified.
Posted by: Obdulantist | August 26, 2007 3:26 AM
I think a very misdiagnosed depression form is social depresion when a all society is affected by a hard stress condition.As a war or a economic caos.I think in Iraq or some areas as Dafur.
Posted by: Jorge Gajardo Rojas | September 25, 2007 5:16 PM
I believe that most of the diagnosis are prescribed because someone must consume those drugs. Not a conspiracy, but not far either.
Posted by: kozmetik | December 23, 2007 2:03 PM
For many people that implicitly means you're a loser; it's perceived as being your fault. If you get a depression diagnosis, it's suddenly no longer a problem with you.
Posted by: directory | January 9, 2008 6:37 PM