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Analysis Too Much Medicine

Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7140 (Published 09 December 2013) Cite this as: BMJ 2013;347:f7140

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Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit

I do agree that there is a lot of unnecessary prescribing of antidepressants. As a psychiatrist, day in day out, I get to see patients’ referred from primary care with a diagnosis of depression being treated with antidepressants. More often than not, majority had been tried on at least two antidepressants before the decision was taken to refer to “secondary care” for “further management”.
Without being able to quote particular figures, I can confidently say however that even though most appeared to have met the criteria for mild to moderate depression, majority did not require pharmacological treatment. Most people had psychosocial difficulties which had a negative impact on their mood and what they simply required was an independent person to hear out their difficulties and then help them to relate it to their low mood.
A Scottish study 1 suggested that the increase in rate of antidepressant prescribing was due to increased incidence, increased prevalence, increased care seeking behiour by patients and improved identification of depression by General Practitioners. While I agree that the incidence and prevalence may increase during economic austerity 2 and this is often associated with increased care seeking behaviour from patients, I do not think that there has been an improvement in General Practitioners ability to detect depression. General Practitioners are under immense pressure to diagnose and formulate management plans for patients within a 10 minute consultation. This time is probably just enough to understand the patients presenting complaint with little or no time to understand precipitating and maintaining factors specific to the patient. Within the time constraints, the easiest default management plan would be to prescribe antidepressants.
Every practitioner involved in providing initial assessments should contextualise patients’ symptoms and experiences. Simply “tightening “the diagnostic criterion for depression does not help in itself, but understanding the story behind the history will certainly cut down on the medicalisation of happiness.

Adeola Akinola
ST6 in General Adult Psychiatry,
Pennine Care NHS Foundation Trust.

1.Munoz-Arroyo R, Sutton M, Morrison J. Exploring potential explanations for the increase in antidepressant prescribing in Scotland using secondary analyses of routine data. Br J Gen Pract2006; 56:423-8
2. Karanikolos M ,Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, Johan P ,Mackenbach P,McKee M. Financial crisis, austerity, and health in Europe. The Lancet, Volume 381, Issue 9874, 13–19 April 2013, Pages 1323–1331.

Competing interests: No competing interests

15 December 2013
Adeola Akinola
ST6 General Adult Psychiatry
Pennine Care NHS Foundation Trust
Fountain street, Ashton Under-Lyne.