Gorden Parker’s paper raises interesting questions.1 Psychiatrists
and general practioners are often met with people presenting their
personal and social difficulties as causing low moods trying to convince
themselves and others that their problems are resulting from an underlying
mental illness thereby avoiding the personal responsibility of their
decisions and actions. Sometimes depressive feelings are mistaken for
depressive illness but it does not respond to antidepressant medication
and can get worse if they are used.2 A sad person though experinces
lowering of mood is capable of enjoying the pleasures of life whereas a
genuinly depressed patient suffers from anhedonia.One of the reasons for
the uncertainty involved in the detection and management of depression is
due to the fact that depression
carries different meaning to different professionals even though
international
criteria have been set out for its assessment. General practoners
perceive
depression differently from hospital psychiatrists. Because there are no
objective
indicators, depression is interpreted differently and the concept of
depression
has been so much stretched that it has nearly lost it’s meaning.
If depression can be considered as a psycho-bio-social condition,
while antidepressants correct the neurotransmitter disease involved
in this illness, cognitive depression is demystified by psychotherapeutic
methods. The controversy whether biological depression precipitates
cognitive depression or vice versa, still remains unresolved.3 But,
cognitive and behavioural factors are relevant to all human experiences.4
A few other reasons that have also contributed to the prevailing
uncertainty in distinguishing and treating mental illness in the primary
care remains unclarified. The belief that anxiety or panic attack could
sometimes be a heralding symptom of depressive illness is thought to
justify premature introduction of antidepressant medication. The recent
media propaganda against minor tranquillisers has also contributed to the
excessive usage of antidepressants in primary care so as to take advantage
of the anxiolytic properties of such drugs. Many general practioners
prescribe anti depressants for cognitive depression along with counselling
hoping it has some prophylactic value against biological depression and
this has not been proved. When antidepressants are used as anti-stress
agents patients are running the risk of getting over diagnosed as
suffering from depressive illness, which can lead to disabling abnormal
illness behaviour as time goes by. The same view can be held against
psychotherapeutic techniques when applied in the medical setting of
primary care. Ideally antidepressants are indicated only when there are
biological symptoms.
Neutralising it with positive life events can heal depression, but
positive life experiences are not always easily available, and people look
for synthetic happiness in antidepressants convincing themselves as
mentally ill.
In many cases, depression could be considered as “a common cold of
mind” but when active suicidal ideas are present, it can be as fatal as
malignancy. This situation puts the psychiatrist into a diagnostic dilemma
when patients express self-harm thoughts. Verbal expression of suicidal
thoughts is more socially acceptable now than years ago. Probably the
higher expression of suicidal thoughts in recent years has also
contributed to the over diagnosis of clinical depression.The rising
incidence of completed suicides is disturbing for the mental health
professionals, but without realising that it is not the sole duty of the
mental health profession to prevent all suicides, clinicians who practice
defensive medicine tend to overdiagnose all such cases as depression.
References,
[1] Parker Gorden. Is Depression Over diagnosed? yes.BMJ.2007;335:328
[2] Cookson. J, Crammer J. Heine B. The use of drugs in psychiatry
1993 p133 Gaskell. London.
Rapid Response:
Over Diagnosis of Depression
Gorden Parker’s paper raises interesting questions.1 Psychiatrists
and general practioners are often met with people presenting their
personal and social difficulties as causing low moods trying to convince
themselves and others that their problems are resulting from an underlying
mental illness thereby avoiding the personal responsibility of their
decisions and actions. Sometimes depressive feelings are mistaken for
depressive illness but it does not respond to antidepressant medication
and can get worse if they are used.2 A sad person though experinces
lowering of mood is capable of enjoying the pleasures of life whereas a
genuinly depressed patient suffers from anhedonia.One of the reasons for
the uncertainty involved in the detection and management of depression is
due to the fact that depression
carries different meaning to different professionals even though
international
criteria have been set out for its assessment. General practoners
perceive
depression differently from hospital psychiatrists. Because there are no
objective
indicators, depression is interpreted differently and the concept of
depression
has been so much stretched that it has nearly lost it’s meaning.
If depression can be considered as a psycho-bio-social condition,
while antidepressants correct the neurotransmitter disease involved
in this illness, cognitive depression is demystified by psychotherapeutic
methods. The controversy whether biological depression precipitates
cognitive depression or vice versa, still remains unresolved.3 But,
cognitive and behavioural factors are relevant to all human experiences.4
A few other reasons that have also contributed to the prevailing
uncertainty in distinguishing and treating mental illness in the primary
care remains unclarified. The belief that anxiety or panic attack could
sometimes be a heralding symptom of depressive illness is thought to
justify premature introduction of antidepressant medication. The recent
media propaganda against minor tranquillisers has also contributed to the
excessive usage of antidepressants in primary care so as to take advantage
of the anxiolytic properties of such drugs. Many general practioners
prescribe anti depressants for cognitive depression along with counselling
hoping it has some prophylactic value against biological depression and
this has not been proved. When antidepressants are used as anti-stress
agents patients are running the risk of getting over diagnosed as
suffering from depressive illness, which can lead to disabling abnormal
illness behaviour as time goes by. The same view can be held against
psychotherapeutic techniques when applied in the medical setting of
primary care. Ideally antidepressants are indicated only when there are
biological symptoms.
Neutralising it with positive life events can heal depression, but
positive life experiences are not always easily available, and people look
for synthetic happiness in antidepressants convincing themselves as
mentally ill.
In many cases, depression could be considered as “a common cold of
mind” but when active suicidal ideas are present, it can be as fatal as
malignancy. This situation puts the psychiatrist into a diagnostic dilemma
when patients express self-harm thoughts. Verbal expression of suicidal
thoughts is more socially acceptable now than years ago. Probably the
higher expression of suicidal thoughts in recent years has also
contributed to the over diagnosis of clinical depression.The rising
incidence of completed suicides is disturbing for the mental health
professionals, but without realising that it is not the sole duty of the
mental health profession to prevent all suicides, clinicians who practice
defensive medicine tend to overdiagnose all such cases as depression.
References,
[1] Parker Gorden. Is Depression Over diagnosed? yes.BMJ.2007;335:328
[2] Cookson. J, Crammer J. Heine B. The use of drugs in psychiatry
1993 p133 Gaskell. London.
[3] Teasdle JD. Cognitive vulnerability to persistent depression.
Cogn. Emotion 1988; 2; 247.7
[4] Simon Jenright Cognitive behavioural therapy—clinical
applications. BMJ 1997; V314, P, 1811-1813.
Competing interests:
None declared
Competing interests: No competing interests