Intended for healthcare professionals

Rapid response to:

Research

Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b750 (Published 19 March 2009) Cite this as: BMJ 2009;338:b750

Rapid Response:

All that weeps is not depression

Doctors listening to the chests of patients with left ventricular
failure will remember that 'All that wheezes is not asthma'. Similarly
when low mood stikes our patients we need to remember that 'All that weeps
is not depression'. Ajustment disorders, bereavement, dysthymia and
borderline personality traits can all present in low mood, and are not
depression, but are easily mislabeled.
The HADS BDI and PHQ9 are all markers of severity of depression, and for
PHQ9 and HADs secreening tools to judge the probability that depression is
present. They are not diagnostic tools.
In particular the fragile labile mood and need for instant relief because
of low frustration tolerance that feature in borderline personality traits
can give very odd results with theses tools. Often the score is heavily
shifted to the severe end.
In the study no attempt seems to have been made to establish the actual
diagnosis for the patients given the tools, other than that they were
given them.
We need to use diagnostic labels carefully, and certainly avoid the easy
trap of low mood is depression needs counselling.

Competing interests:
None declared

Competing interests: No competing interests

26 March 2009
Petre T C Jones
GP
The Project Surgery , Plaistow Newham London E13 0LN