Saturday, August 18, 2007

Too much depression?

Not very long ago, mental illness, particularly depression had this negative stigma. Many were embarrassed to even talk about it. It was thought of as "going crazy" or "going insane." I believe there have been many positive strides in both the recognition, diagnosis, and treatment of depression.

Now, there is a leading British psychiatrist who is saying that depression is being overdiagnosed? He just completed a 15 year study looking at 242 teachers and found that more than 75 percent of them fit the current criteria for depression. (BBC News)
Professor Gordon Parker claims the threshold for clinical depression is too low and risks treating normal emotional states as illness.

He writes in the BMJ [British Medical Journal] that almost everyone [in the study] had symptoms such as "feeling sad, blue or down in the dumps" at some point in their lives - but this was not the same as clinical depression which required treatment.

He said: "Over the last 30 years the formal definitions for defining clinical depression have expanded into the territory of normal depression, and the real risk is that the milder, more common experiences risk being pathologised."
Now, this may surprise you, but I do agree with the professor to a certain extent. Currently, the cultural norms are such that the term depression does not carry as much negative connotation as in the past. In fact, one could argue, that the current en vogue mental illness diagnosis is bipolar disorder as this is more prominent in the media these days.

I would even go as far as saying that there is a certain element of Western culture, especially American culture, which loves to avoid personal responsibility and accountability. I wasn't really speeding, I was responding to my bad day at work, and it's their fault that I was going so fast. Alcoholism is an illness, so I cannot control any of my actions, so I'm not responsible for any consequences.

Don't get me wrong, I believe it is appropriate to treat substance abuse and depression as illness. But, I also believe that some people in the culture use this as an excuse of convenience. And, that is very sad...


Rositta said...

I don't know if depression is over diagnosed or not, possibly, but my own experience I thought I was mis diagnosed. I suffered from a really painful hip. Because of my age they wouldn't even look at it. From the pain I developed fybromyalgia and chronic pain but was diagnosed with depression and given pills. Once the correct diagnoses was made and I had my surgery the pills went in the trash can. I wasn't depressed, I just needed to come to terms with the end of my career. I did that with the help of a good therapist and no pills. I am a very firm believer in personal responsibility, as you say some things need treatment but in some cases it's used as an excuse...ciao:)

Kirsten said...

Personal responsibility - definitely sorely lacking here. People not only don't want to take responsibility, but they want an easy way out. There's a magic pill for everything these days, and it's much easier to pop a pill than to face reality.

I was on Paxil for awhile, and went off it because I didn't want to be on pills anymore. It took awhile, but things are getting much better for me now that I know what I need to do to be happy, rather than popping a pill to exist without being miserable.

Margaret Polaneczky, MD (aka TBTAM) said...

I actually think the statistics are real, but have a different reason as to why. I think we are designed for survival mode, and depression for most of us is a luxury born of extra time and satiation. When all out material needs are satisfied (Food, shelter, TIVO), we start to look around and get dissatisfied with what we have (car not nice enough, hubby not good enough, friends not numerous enough)and that breeds the negativity that we call depression. We up the ante on everything around us, and expect it all to line up with our needs. Since nothing ever will, we get depressed.

My father-in-law told me once that when he got home after being in the trenches in WWII he realized how bad things could really be, and told himself he would never let himself get depressed again. And he hasn't.

Ladyk73 said...

Hm...I just spent nine days in an inpatient psy ward. Damn depression...or bipolar II (the downs without all those pesky highs). Anyways, I am starting Grad school in a week. I have an excuse to "drop out" of LIFE, yet I refuse to drop out of SCHOOL.

I choose to brush myself off an go on... Carefully, maybe more slowly, and with more balance. However, sitting at home waiting for a SSD check is not an option I want to take right now (although I think about it some days).

Anonymous said...

Dr A, I think you hit the nail right on the head. People use "mental illness" as an excuse too many times. We live in a society where it's entirely too easy to blame our problems on someone else (bad parents, crappy job, etc). People need to wise up and take responsibility for their actions!

Dr. A said...

Rositta - It's unfortunate that you were misdiagnosed. Sometimes from our end, we're quick to jump to diagnosing depression without considering other possibilities.

Kirsten - I'm glad you were able to work through things to achieve your goal of getting off pills. I agree with you that personal responsibility is sometimes lacking in people.

Scott - I can't even imagine the ups and downs of having cancer. But, do take it easy on your liver, would ya?

TBTAM - This is a great point. Many have said that this is why we have an obesity problem in America. We have all of our basic needs met, our expectations about everything are raised. And, when they're not met, some call it depression. By the way, great pictures from Italy. For everyone else, check them out here.

Ladyk73 - I'm glad that you brushed yourself off and moving on. Great story of perseverance.

Crazy working mom - I agree. People need to wise up out there!

HP said...

I think depression is a word that's overused. How often do people say they feel depressed when they might be having an off day or two, like we all do? There's a world between that and true clinical depression.

And then there's the difficulty of diagnosing depression in the context of illness where there can be a considerable overlap of symptoms eg. fatigue etc. Do those symptoms represent a manifestation of the illness or are they truly depression? In that scenario, a false diagnosis of depression can occur OR the diagnosis of depression can be missed altogether.

Cathy said...

I wonder about this topic also. After mt knee replacement I felt very depressed but I still think it was because i wasn't receiving proper pain control. Anyway, for the first time ever, i ended up on anti-depressants for a year but I think pain control would have been a better option.

Mother Jones RN said...

Dr. A:

I couldn't agree with you more. It's normal to feel depressed during your life. What can I say, sometimes life sucks; divorce, the death of a loved one, it's a part of life. Healthy people will eventually bounce back with the passing of time, but now people want a quick fix. Patients see their doctor and ask for antidepressants. I’m not against meds, some people really need them, but I really think that they are being over prescribed.

Here & Beyond said...

It is so easy for who m never had depression say anything about it as depressed people were pretenders. I have depression. It is a lack of a substance in my brains. Some "drops" that make a connection between neurons. So, people in general are great judges. Better never talk about you dont really know. Each person has a reason and it must ve veryfied by a professional.