Feature Head to head

Is depression overdiagnosed? No

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39268.497350.AD (Published 16 August 2007) Cite this as: BMJ 2007;335:329
  1. Ian Hickie, executive director
  1. Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2050, Sydney, Australia
  1. ianh{at}med.usyd.edu.au

    Rates of diagnosis of depression have risen steeply in recent years. Gordon Parker believes this is because current criteria are medicalising sadness, but Ian Hickie argues that many people are still missing out on lifesaving treatment

    It is appropriate for the wider community to ask if the benefit of the huge increase in the treatment of depression over the past 15 years has outweighed any harm. If increased treatment has led to demonstrable benefits, and is cost effective, then depression is not yet being overdiagnosed. From a health and economic perspective, we can give a clear answer—more adults are alive and well, and we can easily afford to treat more. Increased treatment of depression reduces suicides1 2 and increases productivity.3 The provision of appropriate medical and psychological care is also cost effective.4

    The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care.5 We have at last abandoned the demeaning labels of stress, nervous breakdown, and adolescent angst. Most doctors can now differentiate normal sadness and distress from more severe and enduring …

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