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John Carteret
Professor Dempster
UNIV 112
November 15, 2015
The Depression Question
In the tenth grade I was diagnosed with depression. The two years that followed
were filled with a turbulent barrage of medications, visits to the “shrink,” and other
psychotherapies. My brand of medication and the dosage changed what seemed like a
thousand times. After two years of searching for a solution to my diagnosed condition, I
moved off to college and simply stopped bothering with it. Miraculously nothing changed,
and the world didn’t fall apart. It would seem that, based on the circumstances, I never had
depression, but rather, the typical teenage hormones associated with puberty. Each year
millions of new cases of depression are diagnosed in the United States, a number that has
steadily climbed since the inception of antidepressants in the mid- 1900’s. But controlled
studies of those allegedly suffering from clinical depression have shown there to be
minimal differences between the use of antidepressants, psychotherapies, and placebo.
This brings up the startling question; why is the diagnosis of depression so much more
prevalent in today’s society? Are doctors hastier to diagnose individuals not truly suffering
from the clinical disorder, is it simply more recognized now than before, or is it actually on
the rise in adults? Through personal experience and collected evidence from various
studies and medical journals, it quickly becomes clear that the diagnosis of depression
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suffers fatal flaws in that the process is expedited and inaccurate. Furthermore
contributing to the atrocious malpractice is the medicalization of sadness by today’s
physicians and efforts by pharmaceutical companies to heavily market psychotropic
medications. These factors require public attention in order to eliminate the overmedication and over-diagnosis of today’s society as whole, and to prevent the barrage of
potential negative side effects of improper treatment.
It is a normal, humanistic condition to feel melancholy at times, however, this does
not mean one has depression. Unfortunately today’s medical field tends to expand the
diagnosis of depression to those who are simply just that, sad. Gordon Parker is a professor
of human science in Australia, and has served on several pharmaceutical advisory boards.
He claims the standard for diagnosing Major Depressive Disorder (MD) bears an
unreasonably low baseline, littered with criteria admitted to show “low reliability.” This
baseline for diagnosis encompasses such symptoms as fatigue or loss of energy, and lack of
drive, both of which are not enough in themselves to truly constitute depression. Both
symptoms are easily explained by external factors not characteristic of a mental imbalance.
Fatigue may result from exhaustion or lack of sleep, and similarly “lack of drive” could
constitute laziness. Based on a 1978 questionnaire, 95% of individuals claimed to have at
least some of the symptoms qualifying a “depressed mood state.” Ian Hickie, the chief
executive officer and clinical advisor of the Australian national depression initiative, says, “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 clinical conditions.” However, such titles are accurate portrayals
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of those who mislabel typical human emotion, especially during the turbulent years of
puberty. These labels, while demeaning, are accurate in showing a lack of clinical
depression (Parker). As a result of opinions like this, individuals without depression
receive improper diagnosis, and furthermore, improper medication.
A survey by the University of Queensland Australia lends to the realization that
over-medication is not solely the fault of physicians in the psychological field;
pharmaceutical industry marketing has been a largely contributing factor to the rise in use
of psychotropic prescriptions (Partridge, et al). When depression medication was
introduced, pharmaceutical companies feared that the drugs would have little to no
market, but now they have grown to hold a “dominant share of the drug market” (Parker).
Prescribing rates of antidepressants are shown to have risen 95% between 2000 and 2011,
a higher rate than any other psychotropic (Partridge, et al). Over use of such drugs, and
over-diagnosis has led to ineffectiveness in the field. Major depression patients generally
react poorly to psychostimulants acting as antidepressants according to a study by Ulrich
Hegerl at the Department of Psychiatry and Psychotherapy at the University of Leipzig, and
in a formal trial of the 1980’s indicates, “…trials in major depression show minimal
differences between antidepressant drugs, 10 evidence based psychotherapies, and
placebo” (Parker). This means that both drugs and therapy make little to no difference in
patients, showing either ineffectiveness or a lack of the condition. There are many potential
risks resulting from the unnecessary use of anti-depressants including exposure to side
effects, waste of financial resources, and negative social stigmas (Partridge, et al). This
array of factors draws attention to the necessity to alleviate the problem
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Beyond the medicalization of sadness and diagnosis of illegitimate symptoms, the
overall process of diagnosing MD is inefficient and expedited, with many saying modern
psychiatry, as a whole needs a new clinical model. The classification scale for MD has
multiple “complicated fits” for various symptoms, leaving physicians unable to place
patients in their correct “slots.” Formal trials of basic criteria for various stages of major
depression were confirmed to show low reliability, and minor depressive disorder further
substantiated less than substantial symptoms, and further more branched in to subclinical
depression, which includes an even greater array of basic human emotional responses,
leading to numbers triple that of major depressive disorder (Parker). Practitioners often
diagnose depression without the use of severity scales, diagnostic instruments, or any
organizational approach. This is extremely alarming in that physicians already suffer much
difficulty placing depression into a definitive sub-category, and those who have already
known risk factors of depression are actually more likely to be misdiagnosed. In eight
studies yielding approximately the same results, in every 100 cases, there are 15 false
positives, and 10 missed cases. In the same study, “general practitioners were only able to
correctly identify 2514 out of 5534 cases,” and additionally showed a misclassification rate
of 25% (Amol, et al). It is shown the shorter appointments also contributed to the
misdiagnosis of patients. “Simply by spending more time examining a patient and learning
more about the severity and classification of their symptoms, doctors can get a more
accurate representation of a patient’s mental health, and thus diagnose them better” (Amol,
et al).
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Despite these three clear arguments for the over-diagnosis and overmedication of
depression, public opinion largely varies on the debate, with some specialists of conflicting
opinion saying there is a barrier to “lifesaving treatment” due to negative stigma. The
aforementioned study by Ulrich Hegerl showed that while Major depression patients
generally react poorly to psychostimulants acting as antidepressants, other sufferers may
respond positively, showing radical inconsistencies. Sixty percent of participants in a
survey say it is acceptable to treat depression with prescription drugs, and older
demographics tend to be the ones who look more favorably upon such treatment. The
paper in association with this study states, “If the public believes mental illnesses are overdiagnosed and drug treatments are over-used as a result, then this may impact their
attitudes towards the accept- ability of treating these disorders with psychotropic
medications. A belief that mental illnesses are over diagnosed and that drugs are overused
may even deter some people from seeking help...” Partridge, et al). This article aims to focus
on the good of society, and the importance of finding help for those who truly need it,
rather than strictly condemning diagnostic standards, while still calling for the revision of
these criteria.
Regardless of opinion on over-diagnosis versus under-diagnosis or any of the
associated stigmas, it can be concluded that there must be a revision of the diagnostic
process. The overall treatment and classification of MD is a flawed system that generates
thousands of false patients and victims of the drug industry. “There is a clear and direct
plan in place to amend the flaws in the diagnostic process, yet it remains unused and
deemed unnecessary” (Hegerl). By changing this ideology, through a restructuring of
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diagnostic criteria, and holding both physicians and pharmaceutical companies responsible
for their actions, there can be a change brought about for those truly suffering mental
health disorders.