Clinical Depression Case Study. Is depression overdiagnosed?
Q.Are too many people being diagnosed with depression?
A.Normal to be depressed and points to his own cohort study which followed 242 teachers. Fifteen years into the study, 79% of respondents had already met the symptom and duration criteria for major, minor or sub-syndromal depression. He blames the over-diagnosis of clinical depression on a change in its categorization, introduced in 1980. This saw the condition split into 'major' and 'minor' disorders. He says the simplicity and gravitas of 'major depression' gave it cachet with clinicians while its descriptive profile set a low threshold. Criterion A required a person to be in a 'dysphoric mood' for two weeks which included feeling "down in the dumps". Criterion B involved some level of appetite change, sleep disturbance, drop in libido and fatigue. This model was then extended to include what he describes as a seeming subliminal condition "sub-syndromal depression." He argues this categorization means we have been reduced to the absurd. He says we risk medicalizing normal human sadness and distress and viewing any expression of depression as necessary of treatment. "Depression will remain a non-specific 'catch all' diagnosis until common sense prevails," concerns about the number of new drug treatments on the market are unhelpful, arguing that new drugs to treat depression have reduced the prescribing of older, more dangerous sedatives and says that the consequences, such as suicide, of not being diagnosed or receiving treatment are rarely emphasized. Audits carried out in the UK, Australia and New Zealand do not support the notion that the condition is over diagnosed, far from it, he says. Instead he points to the diagnosis rate of people with major depression and says this needs to be improved in which case rates of diagnosis must continue to rise. This view was supported by Dr Andrew McCulloch, chief executive of Britain's Mental Health Foundation, who said "It is very unlikely that depression is over-diagnosed in the UK. Vast numbers never seek help: they will struggle; some enough to take their own lives."
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