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Depression Diagnoses
Real emotions have become the lost art of knowing you are human, and when
they arrive, it has become easier to just take a blue pill when clinical
depression symptoms are misdiagnosed. WAKE UP!
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Criteria for Depression too Broad, Researchers Say
03 April 2007 - By Shankar Verdantum -
washingtonpost.com
Up to 25 percent of people in whom psychiatrists would
currently diagnose depression may only be reacting normally to
stressful events such as a divorce or losing a job, according to a new
analysis that reexamined how the standard diagnostic criteria are
used.
The finding could have far-reaching consequences for the diagnosis of
depression, the growing use of symptom checklists to identify those
who may be depressed, and the $12 billion-a-year U.S. market for
antidepressant drugs.
Diagnoses are currently made on the basis of a constellation of
symptoms that include sadness, fatigue, insomnia and suicidal
thoughts. The diagnostic manual used by doctors says that anyone who
has at least five such symptoms for as little as two weeks may be
clinically depressed. Only in the case of someone grieving over the
death of a loved one is it normal for symptoms to last as long as two
months, the manual says.
The new study, however, found that extended periods of depression-like
symptoms are common in people who have been through other life
stresses such as a divorce or a natural disaster and that they do not
necessarily constitute illness.
The study also suggested that drug treatment may often be
inappropriate for people who are experiencing painful -- but normal --
responses to life's stresses. Supportive therapy, on the other hand,
may be useful -- and may keep someone who has been through a divorce
or has lost a job from going on to develop full-blown depression.
The researchers -- including Michael B. First of Columbia University,
the editor of the authoritative diagnostic manual -- based their
findings on a national survey of 8,098 people. They found that those
who had experienced a variety of stressful events frequently had
prolonged periods in which they reported many symptoms of depression.
Only a fraction, however, had severe symptoms that could be classified
as clinical depression, the researchers said.
An estimated one in six Americans suffer depression at some point in
their lives. Under the more limited criteria the researchers urged,
that number would be 25 percent lower.
"The cost of not looking at context is you think anyone who comes
under this diagnosis has a biological disorder, so should more or less
automatically get antidepressant medication, and everything else is
superfluous," said lead author Jerome Wakefield, a New York University
researcher who studies the conceptual foundations of psychiatry.
"There is a trend to treat people in this somewhat mechanized way."
Said First: "One issue this would play out at is at the level of
medication. If someone has a normal grief reaction, you wouldn't give
that person an antidepressant, you would favor counseling. If someone
has major depression you would be more likely to medicate. So this
could influence how clinicians think about medications or
psychotherapy."
Drawing the line between normal and abnormal suffering has long been
controversial in psychiatry, because people who have no disorders
often experience the same symptoms as those who do, but their
reactions typically are less prolonged and intense. Where to draw the
line involves a degree of subjective judgment: If the criteria are too
strict, some people who are depressed may not receive help.
After First oversaw the writing of the current edition of the manual,
for example, a number of doctors contacted him about difficulties they
had in applying the diagnosis, First said. One described a patient who
was feeling acute grief after the death of her dog. The manual says
doctors need not diagnose depression if symptoms follow the death of a
loved one, and the doctor wanted to know whether the death of a pet
met the criterion.
That question, First said, illustrated how difficult it was to
establish a set of criteria that could encompass the complexity of
human sorrow: The death of a spouse or a family member, he said, was
only one of many things that could cause an acute grief reaction.
But he warned that people who are in pain after a divorce or other
stressful event should not conclude that they simply ought to "buck
up." They should seek the counsel of clinicians who would take the
time to explore what caused the symptoms and whether they need
treatment.
Still, Wakefield and Allan Horwitz, a researcher at Rutgers
University who studies the sociology of mental disorders, said their
study, which was published in this month's issue of the Archives of
General Psychiatry, pointed out that sadness has increasingly come
to be seen as pathological in the United States. They have written a
book called "The Loss of Sadness: How Psychiatry Transformed Normal
Sorrow Into Depressive Disorder."
Pharmaceutical companies, the psychiatric profession and patient
advocacy groups have all contributed to the phenomenon, Horwitz
added. Companies stand to make more money from the one-size-fits-all
approach, researchers find the cookie-cutter model of disease makes
it easier to do studies, and psychiatry has come to think of itself
as "the arbiter of normality," he said.
Patient groups, Horwitz added, think that the stigma attached to
mental illnesses would be reduced if they were shown to be more
common.
"The way in which people interpret their emotions is changing," Horwitz said. "People are starting to think that any sort of
negative emotion is unnatural, that they can take medication and
feel better. What that can also do is . . . make it less likely for
people to make real changes in their lives that might be better than
medications." |
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The
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Labors in the Spirits of
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Living on the Lost Planet 
