Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit

Extracts taken from the British Medical Journal (BMJ 2013;347:f7140 doi: 10.1136/bmj.f7140 (Published 9 December 2013)

In England, antidepressant prescribing increased at over 10% each year between 1998 and 2010, a rise far greater than for any other psychiatric medication.

Descriptions of a mental condition can be interpreted in so many ways depending on the perspective of the interested parties. With regard to diagnosing depression as a disorder there are four major players in this arena; firstly there is the psychiatric community who determine and publish the DSM-5. Secondly there is the pharmaceutical industry, thirdly there are the G.P’s and fourthly there is the public itself

The recently published DSM-5 broadened the diagnosis of major depressive disorder to incorporate milder forms of depression and sadness. For example bereavement grief (not an mental illness in itself) became assigned to the status of a major depressive disorder allowing a diagnosis after just two weeks following a bereavement.

In addition the homogenisation of major depressive disorder has been in part a consequence of heavy drug company marketing and an over-strong focus among many psychiatrists on the biological correlates of psychiatric symptoms rather than the psychological, social, and cultural.

For GPs a diagnosis of depression may be an attractive instrument for managing uncertainty in the consulting room, especially as its commonest treatment comes in the form of a once daily pill and is encouraged by clinical guidelines and indicators.

In Western societies there is a trend for the public to expect the right to happiness and a need to restrict the range of negative emotions that are considered unacceptable and abnormal

 Patients often request treatment for symptoms of sadness, and both doctors and patients can feel obliged to offer and accept a diagnosis of major depressive disorder.

There is still a widely held view that all depression is “brain disease” caused by chemical imbalance which can be “corrected” by pills. Countering this belief is all important and achieved by noting the relevance of life circumstances.

Patients can be helped by G.P’s listening carefully to their story, promoting the value of time as a healer and encouraging them to build resilience through  support. A diagnosis of depression as a disorder may not be appropriate. Patients should be able to receive an alternative to pharmaceuticals such as counselling to help them through a complex array of thoughts that have no biological basis

 bmj.depression full article

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