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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

With interest we read the article by Dowrick and Frances. In the article the authors state that “overdiagnosis is now more common than underdiagnosis” in reference to the diagnosis of depressive illness.

From our own practise we find that this is unlikely. The year prevalence of depression is estimated to be 0.9% for the 5 to 16 year old population (1) and 5.6% for the 13-18 year old population (2) . Currently in Newcastle there are 49, 000 young people between the ages of 5-19 (3), 28500 of whom are aged between 5-14 (4). A conservative extrapolation of the above data would suggest that there are 944 young people with depression in Newcastle. As the total number of young people currently within specialist mental health services in Newcastle for any mental health condition is 1, 387, it is highly likely that a substantial number of depressed young people are not in receipt of mental health services.

Indeed, national data suggest that only 27% of children and young people with mental disorders gain access to specialist mental health services (1). Further, according to the same study, only 5 (8%) of the 64 children with depression were prescribed antidepressant medication. Among young people the evidence indicates gross under-recognition and under-diagnosis; this is the real crisis.
Works Cited
1. Green, Hazel, et al. Mental health of children and young people in Great Britain, 2004. 2005.
2. Costello E., Erkanli A. and Angold A. (2006) Is there an epidemic of child andadolescent depression. Journal of Child Psychology and Psychiatry 47: 1263-1271
3. Child health Profile. [Online] March 2013. http://www.chimat.org.uk/resource/view.aspx?RID=152541.
4. 2011, Census. 2011 census: KS101EW Age structure, local authorities in England and Wales. 2011.

Competing interests: No competing interests

24 December 2013
Paul David Sigalas
Senior Registrar in Child and Adolescent Psychiatry
Dr Xanthe Barkla, Dr Paul McArdle
Northumberland Tyne and Wear Trust
Benton House, 136 Sandyford Road, Newcastle upon Tyne, NE2 1QE