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Sunday, August 19, 2007A low threshold for diagnosing clinical depression, however, risks normal human emotional states being treated as illness, challenging the model's credibility and risking inappropriate management. When the first antidepressant (imipramine) was developed, manufacturer Geigy was reluctant to market it, judging there were insufficient people with depression. Now, depression is all around, and antidepressant drugs have a dominant share of the drug market. Reasons for the overdiagnosis include lack of a reliable and valid diagnostic model and marketing of treatments beyond their true utility in a climate of heightened expectations. ...and the no.... ...Closer examination of prescribing patterns 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. Although there has been much hype and regulatory concern about increased prescribing of the new drugs, 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. (emphasis mine) The "yes" thesis rings more true. The "no" thesis reads like a defense of the pharmaceutical industry. He acknowledges that prescriptions for anti-depressants rose sharply in the 1990's, due to promotion of the drugs. In this country, time in history coincides with the birth of direct to consumer advertising. Think you might be depressed? The drug companies can help you find out. Pharmaceutical representatives leave similar questionnaires in waiting rooms around the country. For the past several years (at least as long as Prozac has been on the market), there has been a concerted campaign through to convince doctors and patients that depression is underdiagnosed. It's been my experience that the primary driver of anti-depressant prescriptions over the past decade has been patient requests for them. Most of the time, what drives the request isn't truly depression, but just not being as happy, or at least not as happy as popular culture says we should be. This is the sitcomization of life. A surprising number of people think it's normal to go through life never being disappointed or sad or angry for more than few minutes. If they yell at their kids, something must be wrong with them, and that something must be corrected. It never crosses their mind that perhaps their kids need scolding. Crying is not allowed, not even when the circumstances justify it. It's very difficult to deny these requests. One can attempt to determine how much the sadness affects the ability to get on with life, but in the end, the degree of sadness and the ability to tolerate it is purely subjective. And so, the prescriptions get written. posted by Sydney on 8/19/2007 08:16:00 AM 0 comments 0 Comments: |
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