Carteret 1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949440/
Thesis:
Why is the diagnosis of depression 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 actually on the
rise in adults?
Source:
Parker, Gordon. “Is Depression Over diagnosed? Yes.” British Medical
Journal. US National Library of Medicine. n.p.18 Aug. 2007. Web. 21
Oct. 2015.
Qualifications:
Gordon Parker is a professor of human science in Australia, and has served
on several pharmaceutical advisory boards. The article cites over ten
sources and was originally published by the British Medical Journal.
Parker additionally uses to statistical evidence from these multiple sources
to prove his argument.
Main Claim:
In recent years, the diagnosis rate for depression has risen drastically due
to the “medicalization of sadness,” causing an abundance in the over
diagnosis of individuals with regular human sadness. The author aims to
debunk theories of under diagnosis held by a rival journalist, Ian Hickie.
Sub-claims:
-It is a normal, humanistic condition to feel depressed at times.
-There is an unnecessarily low baseline for diagnosing depression.
-Depression drugs originally were feared to have no market, but have now
grown to have a “dominant share of the drug market.”
-There is no reliable model for diagnosing clinical depression.
-While it is true that many individuals are still not diagnosed, this does not
mean the condition as a whole is under-diagnosed.
Carteret 2
Evidence:
-95% of individuals tested against the 1978 baseline depression
questionnaire, claimed to regularly experience the symptoms indicated in
said questionnaire, showing a “depressed mood state.”
-Upon the drug manufacturer Geigy’s initial development of
antidepressants, it was worried there was not a large enough market for it
to be profitable. Now the drug trade markets treatments to dominant
shares.
-Formal trials of basic criteria for various stages of MAJOR depression were
confirmed to show low reliability.
-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.
-There are screenings in place to eliminate the false diagnosis of breast
cancer patients, even in cases of faulty breast screenings, so why not
depression, which results in inappropriately mandated treatments.
- Studies show minimal differences between antidepressants,
psychotherapies, and placebo.
Important Quotations:
“Minor DSM-III depressive disorder (dysthymia) homogenized less severe
chronic conditions, requiring even fewer and less substantive symptoms
(such as crying, decreased productivity, and feeling sorry for yourself).”
-It seems as though the medical industry is taking advantage of basic
human responses and labeling them as depression, as a vantage point to
sell pharmaceuticals.
“…trials in major depression show minimal differences between
antidepressant drugs, 10 evidence based psychotherapies, and placebo.”
- This means that both drugs and therapy make little to no difference in
patients, showing either ineffectiveness or a lack of the condition.
“The reality that many people with substantive clinical depressive disorders
still do not have their condition diagnosed does not, by itself, mean that
depression is under-diagnosed.”
-This acts as a direct rebuttal to Ian Hickie’s essay, and bluntly states the
Carteret 3
author’s purpose.
Why Use This Source:
This article, paired with it counterpart counter-argument, allow for and
article with a heavy basis on facts. This is important to my chosen issue due
to the high level of controversy and dispute behind it. The opinion voiced in
this article is actual the unpopular opinion and therefore valuable for it’s
direct attempt to disprove under-diagnosis theories, through extensive use
of statistics, and solid historical evidence of malpractice and hesitancy in
the field. Continuing on from this article I will document the opposing
article containing popular opinion, and additionally find more articles that
contain the perfect balance of assertion and evidence that this one does.
Carteret 4
http://anp.sagepub.com/content/48/12/1166
Thesis:
Why is the diagnosis of depression 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 actually on the
rise in adults?
Source:
Hegerl, Ulrich. “ Largely unnoticed flaws in the fundamentals of depression
diagnosis: The semantics of core symptoms.” Department of
Psychiatry and Psychotherapy, University of Leipzig Germany.
Australian & New Zealand Journal of Psychiatry. n.p. Dec. 2014. Web.
25 Oct. 2015.
Qualifications:
The document comes from the Department of Psychiatry and
Psychotherapy at the University of Leipzig, in Leipzig, Germany, and cites
multiple sources, including many different recent and relevant studies
pertaining to the topic. The author has been a board member for multiple
medical boards, as well as pharmaceutical advisories. A fact which further
credits the source in that this is opposite of drug manufacturer agenda.
Main Claim:
The diagnosis of depression has been streamlined causing a decrease in the
reliability and precision of “diagnostic criteria,” and a loss in the validity of
diagnoses.
Sub- Claims:
-Fatigue or loss of energy is not a valid diagnostic criterion
-Fatigue may result from exhaustion or lack of sleep/ sleepiness.
-There is a distinct difference between “lack of drive” and “inhibition of
drive.”
-As a result of misdiagnosis, patients show varying responses to
psychopharmacological treatments.
Carteret 5
Evidence:
-‘Fatigue or Loss of Energy’ is listed as a key symptom in two separate,
independent works of psychology.
-MD patients report “high inner tension and difficulties relaxing or falling
asleep at night as well as during the day,” but fatigue also may result in
increased sleepiness, providing a contradiction.
-Clinicians define a depressive lack of drive as a “high inner tension and a
leaden resistance to the initiation of any mental or physical activity.”
-Major depression patients generally react poorly to psychostimulants
acting as antidepressants, but other sufferers may respond positively,
showing radical inconsistencies.
Important Quotations:
-“Arousal and regulatory systems are one of the five research areas
proposed by the National Institute of Mental Health within the Research
Domain Criteria project, which aims at developing a more valid taxonomy
of mental disorders.”
-There is a clear and direct plan in place to amend the flaws in the
diagnostic process, yet it remains unused and deemed unnecessary.
- “International diagnostic classification systems risk optimizing the
reliability and practicability of diagnostic criteria at the cost of validity.”
-Doctors hasten to throw out the “depressed” classification without
legitimate diagnostic criteria, and as a result endanger patients through
inaccurate treatment.
- “Patients from the opposite ends of the arousal regulation dimension are
put in the same basket.”
-Again, this mixing pot creates unsafe conditions for patients, where
sufferers of other medical problems and different spectrums of illness
receive the same, incorrect treatment.
Why Use This Source:
The provided article gives an analysis coming from a slightly more scientific
angle, allowing for a more convincing data set. The reliable author provides
direct information from medical experiments and journals, which illustrate
Carteret 6
the thesis, showing a disappointingly inaccurate diagnosis of depression,
and individuals from multiple spectrums of the Major Depressive disorder
being “mixed into the same basket” despite the wide variety of their
symptoms and reaction to said symptoms. Additionally, the article touches
on the ineffectiveness of pharmaceutical treatment, and the
inconsistencies in drug use.
Carteret 7
http://www.biomedcentral.com/1471-244X/14/74
Thesis:
Why is the diagnosis of depression 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 actually on the
rise in adults?
Source:
Hall, Wayne; Lucke, Jayne; Partridge, Brad. “Over-diagnosed and overtreated: a survey of Australian public attitudes towards the
acceptability of drug treatment for depression and ADHD.” UQ
Centre for Clinical Research. BioMed Central. n.p. 13 March 2014.
Web. 25 Oct. 2015.
Qualifications:
The authors contributed to the design of the questionnaire used in the
published study in cooperation with the University of Queensland, where
all three parties studied. For their work Brad Partridge was awarded an
NHMRC post-doctoral fellowship, and Wayne Hall was awarded an NHMRC
Australia Fellowship. The data was collected from the Populations Research
Laboratory at the University, and additionally cites multiple sources for the
contribution of external information.
Main Claim:
With a definite increase in the use of psychotropic drugs to treat mental
health problems in Australia, there are still heavily conflicting opinions over
both the use of drugs to treat depression, and the over-diagnosis of the
disorder. Overall, there is a negative view of drug treatment however, and
a majority agreement on the over diagnosis of MD, which is generating a
barrier to effective treatment.
Sub-claims:
- Pharmaceutical industry marketing has been a contributing factor to the
rise in psychotropic prescription.
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-There are many potential risks resulting from the unnecessary use of antidepressants including exposure to side effects, waste of financial resources,
and negative social stigmas.
-Public attitude affects the proper diagnosis of depression.
-Those who view depression as over-diagnosed are less likely to view
psychotropic drugs as acceptable treatment.
Evidence:
-Prescribing rates rose 95% for antidepressants between 2000 and 2011. --- 58 percent of participants agree in the over-diagnosis of depression.
-The use of anti-depressants has increased more than any other
psychotropic.
- Older demographics tend to look more favorably upon treatment through
anti-depressants.
-60 percent of participants say it is acceptable to treat depression with
prescription drugs.
Important Quotations:
-While it is clear that doctors are prescribing more psychotropic drugs, we
know less about people’s attitudes towards drug treatment.
-This line shows the article’s aim towards the humanitarian aspect of overdiagnostic research, an important aspect of the argument for overdiagnosis.
-“The potential risks of unnecessary use of psychotropic medications
include exposure to the side effects of drug treatment; a waste of financial
resources on the part of the patient and the health care system; and
potentially negative social effects of drug treatment, including stigma. “
-There are a multitude of adverse effects from the pedaling of antidepressants by the pharmaceutical industry. This basic list begins to
highlight the key arguments against such practices.
-“If the public believes mental illnesses are over- diagnosed 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...”
Carteret 9
-Again the 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.
Why Use This Source:
Following an article comprised of a mix of scientific data and humanitarian
appeal, and a data heavy article, this publication gives an in depth appeal to
human emotion, while still retaining scientific basis through the use of
survey data. All of the information points towards my thesis of overdiagnosis and over-prescription, while slightly lessening the severity of
accusations to allow for a more emotionally appealing, yet still effective
argument.
Carteret 10
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949449/
Thesis:
Why is the diagnosis of depression 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 actually on the
rise in adults?
Source:
Hickie, Ian. “Is depression overdiagnosed? No.” British Medical Journal. US
National Library of Medicine. n.p.18 Aug. 2007. Web. 25 Oct. 2015.
Qualifications:
Ian Hickie is the chief executive officer and clinical advisor of the Australian
national depression initiative, and has served on professional advisory
boards convened by the drug industry, which have produced national
treatment guidelines and studied antidepressant compounds. The article
cites over ten sources and was originally published by the British Medical
Journal. Hickie additionally uses to statistical evidence from these multiple
sources to prove his argument.
Main Claim:
Despite claims that current criteria for clinical depression are “medicalising”
sadness, many people are still missing out on lifesaving treatment.
Sub-claims:
-The benefits of increased treatment of depression outweigh any harm
caused by it.
-Increased treatment reduces suicides and increases productivity.
-It has also reduced stigma and alcohol/drug misuse.
-Adults benefit less from pharmaceutical treatment.
-There is more harm in not receiving diagnosis than in receiving the wrong
medication.
-Modern psychiatry needs a new clinical model.
-Without recent changes we would still distance ourselves from the
Carteret 11
mentally ill.
Evidence:
-Doctors can now differentiate normal sadness and stress from clinical
illness.
-More adults are alive and well today, and psychological care is more cost
effective.
-Newer practitioners recognize multiple forms of clinical anxiety and
depression, and in turn new studies have developed.
-Pharmaceutical companies heavily promoted the use of anti-depressants
in the early 1990’s.
-Little evidence exists of harm from psychotropic medication.
Important Quotations:
-“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.”
-Such titles are accurate portrayals 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.
-“Without widespread diagnosis of these common conditions, we would all
still distance ourselves, our families, and our communities from the
benefits of receiving mental health care.”
-Indeed there is a need for widespread diagnosis, but in the same breath it
must be accurate diagnosis. There has been a greater acceptance of those
suffering from mental illness, and this is good, but true sufferers must be
distinguished from those embellishing basic human emotion.
-“Although the media often carry stories of young people who have been
harmed by treatment, the stories of those who have benefited receive less
dramatic coverage.”
-Such cases receive less dramatic coverage due to their existence as a
norm. Cases of harm should not exist, or be few and far between. The
existence of such cases in general deserves media coverage, in that there is
Carteret 12
a problem that must be fixed. That problem is misdiagnosis and overdiagnosis.
Why Use This Source:
This source acts as a direct counter-argument to Gordon Parker’s work “Is
Depression Over diagnosed? Yes.” And therefore provides an opposite
stance on the issue which will contribute to an unbiased, factually based
research paper. The majority of Hickie’s points can be argued against by the
dominating views of the paper, which back up my thesis. This article offers
many sub-claims that lack sufficient evidence, giving an argument filled
with holes.
Carteret 13
http://www.sciencedirect.com/science/article/pii/S0140673609608795
Thesis:
Why is the diagnosis of depression 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 actually on the
rise in adults?
Source:
Mitchell, Alex J; Rao, Snajay; Vaze, Amol. “Clinical diagnosis of depression in
primary care: a meta-analysis” The Lancet. ScienceDirect. n.p. 28 Aug.
2009. Web. 25 Oct. 2015.
Qualifications:
Alex Mitchell is part of the Department of Cancer and Molecular Medicine
in Leicester, UK, and all three authors are members of the Leicestershire
Partnership Trust at the Leicester General Hospital and are members of the
Royal College of Psychiatrists. The three psychiatric experts outline the
reasoning, purpose, and results of their data collection and cite many
sources for their additional statistical evidence and study data. All of the
obtained information is relevant, and exists as a six-year-old study, but
contains material still very relevant in 2015.
Main Claim:
Depression is rampantly prevalent in primary care, meaning that
misidentification outnumber missed cases, a statistic which improves by reassessment over an extended examination period.
Sub-Claims:
-Depression is a major burden for the health-care system worldwide.
-Depression rates are higher in urban settings than rural ones.
-Clinicians in all medical specialties have difficulty recognizing mental
disorders.
-Over-detection leads to over-treatment.
Carteret 14
- Practitioners often diagnose depression without the use of severity scales,
diagnostic instruments, or any organizational approach.
-Those who have already known risk factors of depression are more likely
to be misdiagnosed.
-There is a low rate of depression, which allows for identification of nondepressed cases.
-It is difficult to place depression in a definitive sub-category.
-More severe cases of depression are easier to diagnose.
Evidence:
- In every 100 cases, there are 15 false positives, and 10 missed cases.
-Only 54% of individuals meeting diagnostic criteria for depression were
actually deemed to have a psychological illness.
-False positives outnumber false-negatives in a blind study.
-Eight studies gave approximately the same results.
-GP’s were only able to correctly identify 2514 out of 5534 cases.
-They additionally showed a misclassification rate of 25%.
-The classification scale for depression has multiple complicated fits for
various symptoms.
-Shorter appointments compromised diagnosis.
Important Quotations:
- Clinicians can overestimate or underestimate levels of distress of their
patients.
-There is not an accurate way to gauge a patient’s distress, rendering
medical examination, diagnosis, and prescription invalid.
-Accuracy was improved with prospective examination over an extended
period (3–12 months) rather than relying on a one-off assessment or casenote records.
-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.
Carteret 15
-GPs can rule out depression in most people who are not depressed;
however, the modest prevalence of depression in primary care means that
misidentifications outnumber missed cases.
- Evidence and deductive reasoning clearly show that more patients receive
treatment for depression when it is not needed, than patients who truly
need it miss out on treatment.
-When allowed to choose between definite depression, possible (subthreshold) depression, and unclear cases, clinicians rate over a third of their
decisions as not definitive.
-There is no definitive scale for ranking and classifying depression. Leaving
physicians confused over proper diagnosis.
Why Use This Source:
This article offers the most extensive information of any one I have used
thus far. The psychiatric authors give an extensive set of research relating
directly to my thesis topic. By applying this statistical evidence to the Subclaims of this article, which directly match up with the claims of the other
articles and overall paper, the article presents a compelling case for the
misdiagnosis and over-diagnosis of clinical depression. The most compelling
piece of evidence found in this accurate study from such a reliable source,
is that the majority of participants view depression as over-diagnosed.