Is depression overdiagnosed?
Are too many people being diagnosed with depression?
He blames the over-diagnosis of clinical depression on a change in its
categorization, introduced in 1980. This saw the condition split into
'major' and 'minor' disorders. He says the simplicity and gravitas of
'major depression' gave it cachet with clinicians while its descriptive
profile set a low threshold.
Criterion A required a person to be in a 'dysphoric mood' for two weeks
which included feeling "down in the dumps". Criterion B involved some
level of appetite change, sleep disturbance, drop in libido and fatigue.
This model was then extended to include what he describes as a seeming
subliminal condition "sub-syndromal depression."
He argues this categorization means we have been reduced to the absurd.
He says we risk medicalizing normal human sadness and distress and
viewing any expression of depression as necessary of treatment.
"Depression will remain a non-specific 'catch all' diagnosis until
common sense prevails," he writes.
On the other side of the debate Professor Ian Hickie, Professor of
Psychiatry at the University of Sydney and Executive Director of the
Brain & Mind Research Institute argues that if increased diagnosis and
treatment has actually led to demonstrable benefits and is cost
effective, then it is not yet being over diagnosed.
He says increased diagnosis and treatment has led to a reduction in
suicides and increased productivity in the population. Furthermore the
stigma of being 'depressed' has been reduced and the old demeaning
labels of 'stress' and 'nervous breakdown' have been abandoned.
He says concerns about the number of new drug treatments on the market
are unhelpful, arguing that new drugs to treat depression have reduced
the prescribing of older, more dangerous sedatives and says that the
consequences, such as suicide, of not being diagnosed or receiving
treatment are rarely emphasized.