Is Depression Over Diagnosed?

Rates of diagnosis of depression have risen steeply in recent years.  Gordon Parker believes this is because current criteria are medicalising sadness, but Ian Hickie argues that many people are still missing out on lifesaving treatment.
 

Professor Gordon Parker and Professor Ian Hickie are two of Australia's leading psychiatrists, specialising in depression and other mood disorders.  They each wrote an article – one giving the 'Yes' side of the argument and one presenting the 'No' side – and both were were published in the British Medical Journal (BMJ) on 16/08/2007.

We have included introductions to both Professor Hickie's article and Professor Parker's article below here, with links to the full text of each on the BMJ website.

Abstract of Professor Ian Hickie's "No" Opinion

It is appropriate for the wider community to ask if the benefit of the huge increase in the treatment of depression over the past 15 years has outweighed any harm.

If increased treatment has led to demonstrable benefits, and is cost effective, then depression is not yet being overdiagnosed.  From a health and economic perspective, we can give a clear answer—more adults are alive and well, and we can easily afford to treat more.  Increased treatment of depression reduces suicides and increases productivity.  The provision of appropriate medical and psychological care is also cost effective.
 

The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care.

We have at last abandoned the demeaning labels of stress, nervous breakdown, and adolescent angst. 

Most doctors can now differentiate normal sadness and distress from more severe and enduring …

The full text of Professor Hickie's article is on the BMJ website here or in PDF format.

Abstract of Professor Gordon Parker's "Yes" Opinion

It is normal to feel depressed. In our cohort study of 242 teachers, the 1978 baseline questionnaire defined depression as “a significant lowering of mood, with or without feelings of guilt, hopelessness and helplessness, or a drop in one's self-esteem or self-regard.”1 Ninety five per cent of the cohort reported such feelings (with a mean of six episodes a year), indicating the ubiquitous nature of depressed mood states.

A low threshold for diagnosing clinical depression, however, risks normal human emotional states being treated as illness, challenging the model's credibility and risking inappropriate management.

When the first antidepressant (imipramine) was developed, manufacturer Geigy was reluctant to market it,  judging there were insufficient people with depression.  Now, depression is all around, and antidepressant drugs have a dominant share of the drug market.

Reasons for the overdiagnosis include lack of a reliable and valid diagnostic model and marketing of treatments beyond their true utility in a climate …

The full text of Professor Parker's article is on the BMJ website here or in PDF format.