Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Sunday, August 19, 2007

    The Medicalisation of Sadness: Do we overdiagnose depression? The yes...

    A 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


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006