Is depression overdiagnosed? Yes

Abstract

How low do we go?Determining caseness for any dimensional construct requires imposing a cut-off, risking underdiagnosis of true cases or overdiagnosis of non-cases. By 1993, 79% of teachers in our cohort (in their late 30s) had already met symptom and duration criteria for lifetime major, minor, or subsyndromal depression (unpublished data). Although it was absolutely necessary to redress psychiatry's earlier weighting to melancholia, the extended dimensional model risks medicalising normal human distress and viewing any expression of depression as mandating treatment. 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 underdiagnosed. Such boundary concerns have multiple parallels. For example, the diagnosis of attention-deficit/hyperactivity disorder is often missed; conversely, it is often falsely diagnosed in children with other disruptive behaviours.