I am not questioning those who are quite clearly depressed. The question is for those who maybe feel “down”, sad, not quite themselves, not sleeping well. Perhaps they have suffered a major life event such as a bereavement, the breakdown of a relationship, redundancy. These are the folks whom practical advice and support and/or an “alternative” approach really can help; they do not need to be numbed from what they are feeling through inappropriate use of medication.
It is a question thrown up by Dr Chris Dowrick in his research last year, reported in the press – Depression ‘over-diagnosed’ with drugs dished out to patients who are simply sad or unable to sleep, warns expert.
It is summarised as follows in the BMJ :
Medicalising unhappiness : new classification of depression risks more patients being put on drug treatment from which they will not benefit.
- Clinical context—Diagnoses of major depressive disorder and treatment with antidepressant drugs are increasing
- Diagnostic change—DSM-III homogenised the diagnosis of depression and the new DSM-5 classification broadens the definition further, allowing the diagnosis of major depressive disorder just two weeks after bereavement
- Rationale for change–To provide more patients with access to effective treatments
- Leap of faith–Accurate diagnosis of mild depression is possible; treatment is necessary and leads to better outcomes
- Increase in disease—Although community prevalence of major depressive disorder has remained static, diagnoses doubled among Medicare recipients in the US between 1992-95 and 2002-05
- Evidence of overdiagnosis—Depression is now more likely to be overdiagnosed than underdiagnosed in primary care. Rates of prescribing of antidepressant medication doubled in the UK between 1998 and 2010 and in the US 11% of the population aged over 11 now takes an antidepressant. People without evidence of major depressive disorder are being prescribed drug treatment
- Harms from overdiagnosis—Turning grief and other life stresses into mental disorders represents medical intrusion on personal emotions. It adds unnecessary medication and costs, and distracts attention and resources from those who really need them
- Limitations—We do not know whether clinicians will follow the DSM-5 proposals
Conclusions—Patients with mild depression or uncomplicated grief reaction usually have a good prognosis and don’t need drug treatment. Clinicians should focus on identifying people with moderate to severe depressions and sufficient impairment to require treatment. BMJ, 9 December 2013
So, the guidance on a diagnosis for depression allows someone who may be grieving for a loved one to be diagnosed as having a “major depressive order” after just two weeks! That’s basically most of us! Which of us who has lost someone they love deeply would not still be grieving after just two weeks! How many of us two weeks on from such a major trauma would not prefer to be curled up alone with our memories and some time to process our emotions? In fact, it would be unusual not to be sad for some time after we suffer such a loss. Of course, for some people the sadness does not shift and it does become depression, but they are not the ones we are talking about here. We are talking about you or me showing up at the GP two weeks after a loved dies and saying I am not sleeping, I feel so sad, I don’t feel up to going back to work , etc. The response in such cases should not be a diagnosis of depression requiring medication!
The irony is that we have more knowledge and information (and access to that knowledge/information) than ever before, and yet the diagnoses for depression are increasing. As Dr Dowrick’s study clearly highlights, this is not because more of us are actually suffering depression:
Although community prevalence of major depressive disorder has remained static, diagnoses doubled among Medicare recipients in the US between 1992-95 and 2002-05
That reference is to the US but in the UK we tend to follow where the US leads, and his next point bears this out :
Depression is now more likely to be overdiagnosed than underdiagnosed in primary care. Rates of prescribing of antidepressant medication doubled in the UK between 1998 and 2010
Doubled in 12 years!! Where is the evidence that justifies that rate of increase in prescribing anti depressants? The medical reps may well be pushing sales on the premise that medicating “mild” depression aids recovery, but the evidence says otherwise :
In patients with mild to moderate depression symptoms, there is little or no benefit of antidepressant medications compared with placebo. Medications are more beneficial in patients with severe depression. – Cochrane Review, Effectiveness of Antidepressants Compared with Placebo for Depression in Primary Care
Interestingly, this review was based on 14 studies, most of which were funded pharmaceutical companies! No wonder we don’t get to hear about them! Don’t take my word for it, take the time to do your research and there is plenty more of the same accessible online.
This is an interesting issue to ponder alongside how we remove the stigma of depression for those who are suffering it. Let’s pray that as a consequence of a breakthrough on that front, we don’t inadvertently make anti-depressants appear even more justifiable and acceptable in all cases!
Dr Dorwick concludes –
- Harms from overdiagnosis—Turning grief and other life stresses into mental disorders represents medical intrusion on personal emotions. It adds unnecessary medication and costs, and distracts attention and resources from those who really need them………….
- Conclusions—Patients with mild depression or uncomplicated grief reaction usually have a good prognosis and don’t need drug treatment. Clinicians should focus on identifying people with moderate to severe depressions and sufficient impairment to require treatment.
The irony will not be lost on those who really are experiencing depression, that once you are in that state it usually takes you and those close to you a lot longer than two weeks to realise what is happening. Catching depression as early as we can is imperative; it makes treatment so much easier, whatever the modality. However medicating when drugs are not required can worsen what might have been an easily remedied state. Ask those who have experienced weaning themselves off anti depressants how awful that experience is!
If you feel sad or down, whether it is grief or some other cause, such as post natal symptoms, or related to some other medical condition or an accident or event, do seek help. Talk to family and friends if you feel able. Sometimes it is easier to talk to a third party; call the Samaritans, go online and talk to others. Do go and see your doctor if that feels like the right thing to do, but go armed with knowledge so you are better placed to avoid medication as a quick fix. Above all, make sure you get support; we all need that from time to time, even if we are not depressed.
If you come to me for help, the process is quick and simple in the first instance. When you book your session, tell me in a sentence what the issue is and let me do the session for you. That’s all I need. No personal information, no intrusion, no need to even speak to me or see me. You don’t need to prepare anything or be or do anything in particular during the session. If you are already taking medication, change nothing. I will contact you afterwards, by which time you will likely have experienced some shift already. There is nothing to lose and everything to gain. Read the testimonials section for recent feedback from clients.