BMJ  2007;335:413-414 (1 September), doi:10.1136/bmj.39317.492130.BE

Letters

Is depression overdiagnosed?

Global perspectives

The debate on whether depression is overdiagnosed should take global and epidemiological perspectives into account.^{1 2}

Recent transnational epidemiological surveys have not confirmed that medicalisation of sadness is a general phenomenon in the community.³ Rather, a substantial proportion of individuals with depression, even of severe degree, do not receive drug or other professional treatments. This is especially so in developing countries (including Beijing and Shanghai in China), where typically less than 10% of people with mood disorders will ever receive any form of professional treatment.⁴

The epidemiological meaning of a "case" of depression (such as mild major depressive episode) may have little to do with whether the affected person needs psychiatric evaluation or drug treatment, or both. This is not unlike increasingly lenient public health definitions of physical conditions such as obesity or serum cholesterol concentrations in the general population. In the spirit of early intervention, psychosocial intervention or a change in lifestyle may work better than drugs in alleviating such mild metabolic disturbances.

The real problem for the increasing diagnosis of depression is the poor access to quality psychosocial interventions such as cognitive therapy not only in developing countries but also in much of the developed West. This is despite a strong base of evidence showing that such interventions are at least as effective as drugs in treating and preventing depression. In many parts of the world clinical psychology does not exist.

Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region

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Competing interests: None declared.

References

1. Parker G. Is depression overdiagnosed? Yes. BMJ 2007;335:328. (18 August.)[Free Full Text]
2. Hickie I. Is depression overdiagnosed? No. BMJ 2007;335:329. (18 August.)[Free Full Text]
3. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581-90.[Abstract/Free Full Text]
4. Lee S, Fung SC, Tsang A, Zhang MY, Huang YQ, He YL, et al. Delay in initial treatment contact after first onset of mental disorders in metropolitan China. Acta Psychiatr Scand 2007;116:10-6.[CrossRef][ISI][Medline]

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