This New York Times article, entitled
Many Diagnoses of Depression May Be Misguided, Study Says
brings up a valid point about diagnosis. As I’ve said before, since we base “diagnosis” in the mental health field on self reports from clients, often checking off boxes on a form, the term “diagnosis” is misleading. In the medical field, the word generally has some physical, empirical basis. An observable bacteria, a lesion, specific physical symptoms. Of course we even misuse the term “empirical” in the field of psychology, using this word when the “empirical” data we are referencing are really subjective self report survey data.
So this article discusses the idea that depression may be over-diagnosed because recent life events that could make someone temporarily sad are not taken into account. The opposing view says that the diagnostic criteria clearly differentiate between short term depression and long term depression. And of course the DSM does have such distinctions.
The key is, however, “What difference does it make?” If those with the appropriate credentials prescribe anti-depressants for either condition (which they do) what difference do the DSM categories make?
I was working with a recovering addict who was withdrawing from Oxycontin, pot, and who knows what else. He was in a long term residential treatment program. He saw a psychiatrist at one point within the first 30 days of recovery, who saw him for 10 minutes and prescribed Effexor. For someone in their first 30 days of withdrawal from drugs, being a bit blue (to put it mildly) is normal. Anti-depressants might be a valid treatment at some point, but don’t you think we should allow some time to find out what life is like without drugs first?
Have we tried an exercise program? A meditation program? A proper diet? Can we charge money for these things? No. Have they been shown to be as effective as medication? Yes. How many people who are prescribed anti-anxiety drugs have been asked by the prescriber how much caffeine they consume on a daily basis? Is it on the check list? No. Does the check list ask about exercise, diet, vitamin supplements, sleep patterns, relationships, major life events, etc.? No.
What is the point of “diagnosing” in these situations? Why are we not doing thorough assessments? Well, maybe some of us are doing these types of assessments. But my impression, based on the drugs being sold, and based on the time constraints of those who have the prescription pads, is that we are getting more 10 minute prescriptions than we are thorough life assessments.
I don’t think the question is whether we are “over-diagnosing” or not. I think the question is “Why are we diagnosing, instead of assessing, talking, and helping?
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psychology schools » Depression? (4/3/2007)
8 Comments to
“Depression?”
Oh the delicious iron of the add at the side asking readers whether ‘depression could really be part of bipoar disorder’ Love it!
re your note - I pretty much agree, the diagnosis bit I guess doesgive some indicatons of course or prognosis I would have thought, a way to communicate and to frame interventions - be they ‘pull yourself together’ occupational therapy (*you left that one out), or all the lifestyle and normal things you suggest.
I’d have to agree with you. I think we are slowly falling into a pit where every bad feeling is a sign of something more serious, e.g., depression. In fact, in our graduate school training, students were warned they would see symptoms that were very familiar to some but not to believe that just because you have a symptom or two that you have that diagnosis.
The truth is, sometimes we go through crappy situations in our lives. We’re going to feel bad. Sometimes for weeks or even months. When there’s an obvious precursor to a person’s depressive feelings, individuals should try many self-help methods (many of which Greg mentioned) to help themselves first.
Depressive feelings does not automatically equal depression. And not all depression should automatically be treated with an antidepressant right off the bat. It depends on the person, the severity of the depression, and many other factors.
These days, people are being bombarded by ads for antidepressants in magazines and television. As it is, most antidepressants are prescribed by family doctors who tend to represent the only source of treatment a lot of people ever get. Perhaps the key is educating family doctors about treatment options for depression.
Family doctors are unfortunately in a tight spot. One good way to make money in a tightening environment of constraints from insurance companies is to give patients what they want, and keep them coming back. If patients come in seeking drugs, and the doctor gets paid for a quick office visit in exchange for a prescription, well, it helps the bottom line.
I recently changed doctors. The guy I was seeing normally had 3-4 drug reps in his office every time I was there. There is a flow of money to doctors from pharmaceutical companies and market research companies who pay doctors to participate in discussions, pay them to attend informational dinners, pay them to… So this is another way to improve the cash flow.
There is just no lobby for the opposing view. Nobody clamoring for doctors’ time to tell them not to give patients what they want - not fill needs that have been created by advertising directly to patients.
We want a quick, simple solution that doesn’t require much effort on our parts. I feel for the family doc - who is getting it from all sides. I’m not surprised that some of them cave in. But not all of them do. And of course there are drugs that have helped a great many people. As in most things, “Yes” or “No” is not the question. The questions are “How often?” “In what situations?” “How much research have we done with this patient?” “What else has been tried?” And so on.
Yes, why not consider an alternative treatment before considering antidepressants. These assupmtions may be the cause of some conditions wherein patients are given antidepressants which were not necessary on the first place.
I recently read an amazing article from a fantastic Chinese doctor on treatment of various Liver problems and Hepatitis C, etc..
There are also some very interesting alternative treatments for Anxiety and Depression on his site
http://www.alchemistlab.com/otherillnesses4.html
Eric
I am with the alternative ways. A good exercise and other fun activities can be as effective as antidepressants. Some patients probably just needs these activities and not antidepressants.
This is why I’m glad my psychiatrist saw me for 2 hours the first visit. He really listened to me and didn’t just write me a script for pills. Therapy and pills are a good combination, along with a holistic lifestyle change to combat depression.
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Last reviewed: By John M. Grohol, Psy.D. on 3 Apr 2007
