Is depression overdiagnosed? No

Abstract

Caveats and concernsAlthough those under 18 years old seem to benefit from psychological and drug treatments, the evidence is not as strong as for adults.13 The resulting community concern should focus on whether drugs or psychological approaches are given as first line treatments rather than whether depression should be diagnosed in young people. As with adults, among young people with more severe disorders the overall response to treatment is encouraging.14 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.Closer examination of prescribing patterns15 reveals other interesting and health promoting patterns. Firstly, although the number of prescriptions for antidepressant drugs rose sharply during the 1990s, it now seems to have slowed. Secondly, the use of new antidepressant drugs often results in reduced prescribing of less desirable sedatives such as benzodiazepines, as well as the more dangerous tricyclic antidepressants and monoamine oxidase inhibitors.15 Although there has been much hype and regulatory concern about increased prescribing of the new drugs,13 there is little hard evidence of harm to a significant number of people. The real harm, as evidenced by the suicide statistics, comes from not receiving a diagnosis or treatment when you have a life threatening condition like depression.The real action in managing depression is in primary care settings. Large general practice based audits in the United Kingdom, Australia, and New Zealand do not support the notion that depression is now overdiagnosed or treated exclusively with antidepressant drugs. In fact, substantive personal, demographic, geographical, professional, training, and health system capacity barriers remain in place. The net result seems to be that diagnosis of major depression is largely restricted to people with more severe or persistent disorders, those who present many times, those who request treatment, or those who attempt self harm.16