is depression over diagnosed

[kazza27]

why is it,that some people can go through hell and not get any forms of mental illness and yet some people have the life of riley and yet get depression.
i know these twin girls who have everything they want,go out clubbing every night yet were diagnosed with depression
my dad was diagnosed with depression and he is the total opposite,before meds all he did was lie in bed all day,not eating or drinking

so i wonder if depressions over diagnosed these days

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[whopper]

I'm not going to give a simple answer.

Is it overdiagnosed? Yes and no.

No-several people who truly have depression in the DSM IV criteria of the definition do not seek medical help.

The DSM is the manual psychiatrists use to diagnose a mental illness.

Yes-several doctors who give out antidepressants do so in a manner that does not meet the DSM criteria, or anything close to it. E.g. person comes in to the doctor's office, mentions they are depressed because they had a bad day, and the doctor without going through the proper criteria gives an antidepressant. Since that medication requires a diagnosis of depression for billing purposes the doctor writes that down.

This is actually a case of the doctor just trying to process patients in the fastest manner possible, and not truly examining the issues affecting the patient.

Simply feeling bad over a bad day is a normal, its not a sign of true clinical depression in the manner.

So while overall, depression is underdiagnosed, you will have specific health professionals giving out psychotropic meds too liberallly--causing overdiagnosis for that person's patients.

 

[kazza27]

I'm not going to give a simple answer.

Is it overdiagnosed? Yes and no.

No-several people who truly have depression in the DSM IV criteria of the definition do not seek medical help.

The DSM is the manual psychiatrists use to diagnose a mental illness.

Yes-several doctors who give out antidepressants do so in a manner that does not meet the DSM criteria, or anything close to it. E.g. person comes in to the doctor's office, mentions they are depressed because they had a bad day, and the doctor without going through the proper criteria gives an antidepressant. Since that medication requires a diagnosis of depression for billing purposes the doctor writes that down.

This is actually a case of the doctor just trying to process patients in the fastest manner possible, and not truly examining the issues affecting the patient.

Simply feeling bad over a bad day is a normal, its not a sign of true clinical depression in the manner.

So while overall, depression is underdiagnosed, you will have specific health professionals giving out psychotropic meds too liberallly--causing overdiagnosis for that person's patients.

thanks for answering my question.

 

[GH253]

In my opinion, depression is an arbitrary label and not a condition distinct from normal feelings of unhappiness and dissatisfaction. The reason some people become depressed while others don't is that they have different ideological/philosophical orientations, i.e. different values, goals, beliefs, etc. which cause them to evaluate events in thier lives differently.

 

[whopper]

The DSM criteria does not make the dx completely objective, but it does remove much of the subjectivity with the dx.

If an doctor correctly used the DSM criteria, and the person voluntarily agreed to take an antidepressant, I'd have no problem with it. If one were forced to take it, it could only be within a context that the person was dangerous, and it'd have to be verified by a judge (At least in all the states that I'm thinking about.)

However a problem I'm seeing is doctors just give them out after one mention of "depression." People use the word "depression" not in the same context that the DSM considers clinical depression.

 

[notdeadyet]

In my opinion, "depression" is an arbitrary label and not a condition distinct from normal feelings of unhappiness and dissatisfaction.

It's a bummer that depression doesn't have a nice clinical-sounding name like schizophrenia or hypothymia or somesuch. It's a shame that a clinical condition bears the name that your average layman uses very loosely.

The reason some people become "depressed" while others don't is that they have different ideological/philosophical orientations, i.e. different values, goals, beliefs, etc. which cause them to evaluate events in thier lives differently.

True. That's why "depressed mood" is only one part of the criteria that someone needs to meet to be considered clinically depressed.

Someone feeling down because of their culture, philosophy, and beliefs is not clinically depressed. Someone feeling down, not eating, unable to sleep, unable to enjoy their life's passions, and contemplating suicide? It's not an ideological/philosophical issue. They're probably clinically depressed and in need of clinical treatment.

 

[whopper]

The reason some people become "depressed" while others don't is that they have different ideological/philosophical orientations

Notdeadyet already addressed your comment, however I just wanted to add. The DSM clearly states that when diagnosing a disorder, the cluster of signs and symptoms has to be to the point where it is causing the person distress and/or harm, and is above the extreme of the cultural norm. It also clearly states to consider cultural factors, and that the person may have a different philosophical viewpoint on things.

The problem is not the DSM, or the field of psychiatry as it is with the human factor of some lazy people just wanting to get the person out of the door so they could make more money in shorter time (some places you get paid more for the more patients you see) or because they wanted to get out of work earlier. It occurs in all fields. Its of course especially worse in a field such as the medical field because a person's health is at stake, yet it still happens.

 

[OldPsychDoc]

...
The problem is not the DSM, or the field of psychiatry as it is with the human factor of some lazy people just wanting to get the person out of the door so they could make more money in shorter time (some places you get paid more for the more patients you see) or because they wanted to get out of work earlier. It occurs in all fields. Its of course especially worse in a field such as the medical field because a person's health is at stake, yet it still happens.

There is also the "human factor" especially in the Western world, of wanting a pill to "fix" things. We see the same thing with anitbiotics being prescribed for viral illness, etc.

I'm just saying, don't just blame the doctors...look at the attitudes in our culture (from which our patients come.)

 

[whopper]

I'm just saying, don't just blame the doctors...look at the attitudes in our culture (from which our patients come.)

True, but the doctor must also act as the gatekeeper to prevent that type of practice. If a patient comes into the office demanding a medication, we're not just supposed to provide it.

I will fully disclose that IMHO too many doctors give out too many meds. My outpatient moonlighting gig I currently have, I'm still getting my patients off the long list of meds where the previous doctor put them on that I still don't understand why he did what he did. I am confident I'm doing the right thing because the overwhelming majority are feeling better with my approach.

E.g. patient has panic DO (with enough DSM criteria for it), but he diagnosed her with Mood DO NOS, and he made her meds
meds.....
Welbutrin, Geodon, Seroquel, Topamax, and Ranitidine.

I took her off of everything except Ranitidine--took 2 months to taper it all out and put her on Citalopram.

Panic attacks are down from 3x a day to 1-2x per week. I can't get her off the Ranitidine because now if she stops it she gets GERD, but didn't have GERD before this previous doctor started it.

It could be that the frustration over this previous doctor's work has colored my opinions with bad prescription practices, but he's not the only one I've seen who works like this.

 

[michaelrack]

MDD is probably over diagnosed; Adjustment d/o and dysthymia are probably underdiagnosed. Just my opinion, don't have any citations.

 

[billypilgrim37]

Appendicitis is also overdiagnosed.

 

[masterofmonkeys]

MDD is probably over diagnosed; Adjustment d/o and dysthymia are probably underdiagnosed. Just my opinion, don't have any citations.

mine too.

 

[splitastone]

In my opinion, depression is an arbitrary label and not a condition distinct from normal feelings of unhappiness and dissatisfaction. The reason some people become depressed while others don't is that they have different ideological/philosophical orientations, i.e. different values, goals, beliefs, etc. which cause them to evaluate events in thier lives differently.

Could you expand on the above? This is a brilliant observation. What led you to this conclusion?

Thanks - Sean

 

[Indryd]

Could you expand on the above? This is a brilliant observation. What led you to this conclusion?

Thanks - Sean

Oooooh rofl.

Looks like someone made a new account to butter themselves up and/or justify posting some more goofy nonsense.

 

[splitastone]

Oooooh rofl.

Looks like someone made a new account to butter themselves up and/or justify posting some more goofy nonsense.

Why would you assume this?

How did you arrive at the conclusion that the post was/is goofy nonsense?

 

[Indryd]

Why would you assume this?

How did you arrive at the conclusion that the post was/is goofy nonsense?

depression is an arbitrary label and not a condition distinct from normal feelings of unhappiness and dissatisfaction.

Because every medical student in his/her first year, or even an undergrad in abnormal psychology, gets it drilled into his/her head that by definition depression IS "a condition distinct from normal feelings of unhappiness and dissatisfaction."

That phrase is pretty much essential to defining clinical depression and certainly essential to making the diagnosis.

 

[splitastone]

Because every medical student in his/her first year, or even an undergrad in abnormal psychology, gets it drilled into his/her head that by definition depression IS "a condition distinct from normal feelings of unhappiness and dissatisfaction."

That phrase is pretty much essential to defining clinical depression and certainly essential to making the diagnosis.

Thanks for clarifying - Sean

 

[kugel]

mine too.

Your depression was overdiagnosed?

 

[kugel]

a friend of mine at work the other day made the observation that when antidepressants all had more side-effects and more risk overall (MAO-I's and TCA's) psychiatrists did take more care to assure that the level of depression was sufficiently severe before prescribing. That's because there was more at stake. "Those things could kill 'ya." So it certainly made sense to spend more time/effort ferreting out the exact level of the precise symptoms before prescribing something so fraught with potential problems.

Since the advent of "newer" gen. AD's (Prozac and everything since), it is much more reasonable for PCP's to hand out antidepressants for "every little complaint of depression" since there is so much less chance of serious (even fatal) complication. My friend was also quick to point out that when this revolution occurred, he assumed that few of these patients who'd been handed a quick AD would actually be helped. "I was wrong. A surprising number did (and do) get better by just being handed an Rx for the latest antidepressant. And if prescribing 1-2 AD's doesn't work, then it probably is time to refer the pt on to a psychiatrist."

But the same friend pointed out that we really do have to diagnose depression almost entirely, sometimes completely entirely, on patient report. There are often NO objective symptoms (no less tests). We have to be honest with our patients (and ourselves) that we are simply listening to the patient complaints and then recommending medicine or not.

While that's not true in nearly all of psychiatry, it certainly is true, at least some of the time, in depression. And, of course, patients ARE capable of minimizing, exaggerating, or simply lying about symptoms in order to get AD's (why they do, I don't really understand, but they do).

 

[dl2dp2]

Actually, I think according to most of the public health oriented literature on this, MDD is UNDER-diagnosed, not overdiagnosed. For every bratty 18-year old overmedicated by their helicopter parents, there are 10 African American, rural residents, hispanics, Asians, suburban fathers, etc. who should be treated either through psychotherapy or medication, but isn't. Stigma is pervasive especially in poor, minority groups.

Your impression that depression is overdiagnosed is a product of the social biases through your particular cultural milieu.

There is strong evidence that what we call MDD is probably a heterogenous entity, with a subgroup of patients having real "neurological" problems, and can be treated effectively with things like DBS/TMS...it could also be strictly a magnitude issue. The statistical structure of the phenomenology of depression is understudied.

 

[Shikima]

MDD is probably over diagnosed; Adjustment d/o and dysthymia are probably underdiagnosed. Just my opinion, don't have any citations.

You know, I have begun to wonder this too. I find myself more recently using these diagnoses than MDD, rec, severe w/o psychoic features.