Are doctors diagnosing too many with depression?

19 August, 2007:

A leading psychiatrist has come out against too many patients being diagnosed with depression and being prescribed anti-depressant drugs.

Professor Gordon Parker, of the Black Dog Institute in New South Wales, Australia, has said that prescriptions for anti-depressants have soared to an all-time high in the United Kingdom, with over 31 million prescriptions written in 2006 alone, a 6% rise over 2005.

Professor Parker carried out a study of 242 teachers and followed them up for 15 years. During that time, more than three-quarters of the teachers met the current criteria for depression.

These criteria are having a ‘low mood’ for over two weeks combined with appetite change, sleep disturbance, drop in libido, and fatigue.

But, minor depression also has less-defined and severe symptoms such as crying a lot, decreased productivity, and feeling sorry for oneself.

Professor Parker claims that normal emotions are sometimes being treated as illness because the threshold for clinical depression was too low.

He called depression a “catch-all” diagnosis driven by clever marketing that supported a thriving prescription-drug industry. There is an over-reliance on anti-depressants, he alleges.

Under the current diagnosis guidelines, about one in five adults in Britain is thought to suffer depression during their lifetime. This costs Britain’s economy billions in lost productivity and treatment.

Professor Parker concluded that a low threshold for diagnosing clinical depression risks treating normal emotional states as illness. Prescribing medication may raise false hopes, whereas the treatment will not be effective because there is nothing biologically wrong with the patient, he explained in the British Medical Journal.

Professor Parker has found critics. Professor Ian Hickie, of Sydney University’s Brain and Mind Research Institute, Australia, wrote in the British Medical Journal itself that increased levels of treatment has led to demonstrable benefits among patients, and therefore it was wrong to say that depression is being diagnosed too often.

According to Professor Hickie, increased diagnosis and treatment had also led to a reduction in suicides and the stigma about mental illness.

In addition, he said, though there have been concerns about new anti-depression drugs on the market, such as selective serotonin reuptake inhibitors (SSRIs) – which have been linked to increased suicidal thoughts in adolescents – they are still safer than the old drugs.

The real harm, Professor Hickie stresses, comes from not receiving a diagnosis or treatment when one has a life-threatening condition like depression.

He also said the condition “should be given a sliding scale of severity so that patients with the least distressing forms of depression do not receive overly aggressive treatment.”

Marjorie Wallace, chief executive of SANE, one of Britain’s leading charities concerned with improving the lives of everyone affected by mental illness, also differed with Professor Parker, saying that steering away from diagnosing depression risked ill people committing suicide.

It is better to risk over-diagnosis than to leave depression untreated, she said, adding that one in ten people with severe depression may take own life.