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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 read the article with great interest as this is a fairly common experience for Community Psychiatrists to see people being prescribed antidepressants fairly soon after stressful life events often within days. There is evidence from from antidepressant trials that a number of patients improve during the single-blind placebo period or "washout" (Rabkin et al)of 10 days. This is particularly true for mild depression. This suggests that holding off prescribing antidepressants at the first consultation following a stressful life event allows for the full clinical picture to develop.As the authors suggest watchful waiting should be the first intervention in many mild cases.

The other concern is that it is not for depression alone that antidepressant get prescribed but for anxiety disorders as well where the placebo response tends to be even higher. This may also add to the increase in antidepressant prescribing. Overdiagnois is not restricted to depression alone as more recently there is a rise as well in the diagnosis of Bipolar II and Adult ADHD where the criteria have similarly been made looser.

I think the BMJ should be commended for highlighting this issue.

Rabkin, J. G.,Stewart, J.W., McGrath, P. J., Markowitz, j. S.,Harrison, W.,and Quitkin, F. M. (1987)
Baseline characteristics of 10-day placebo washout responders in antidepressant trials.
Psychiatry Research,Vol. 21, Issue 1, 9-22.

Competing interests: No competing interests

16 December 2013
Sadgun Bhandari
Consultant Psychiatrist
Hertfordshire Partnership University NHS Foundation Trust
QE II Hospital, Welwyn Garden City, Hertfordshire AL9 4HQ