The reason I ask is because I definitely get this impression. Likewise, I was especially surprised at how easy it was to obtain a perscription of anti-depressants. After only one visit to a pediatric doctor (I’m 17. Yeah, I know–someday I’ll visit a doctor for “grown-ups”) I was put on Prozac. Later, after it didn’t work, I was referred to a psychiatrist.
Perhaps I have a skewed perspective on this matter since ALL of the members of my immediate family, and a large portion of my extended family, are on anti-depessants. But I also know a good number of friends, adult and teens alike, that are also on AD’s. In fact, I would say about 10% of the people I know are on medication.
While obviously a nuanced mental disorder like depression can be very subjective in its diagnosis, shouldn’t medication be a last resort as a treatment for mild depression.
Can’t a little suffering be good, or perhaps even natual?
Well doctors aren’t a monolithic entity. I suppose each doctor would have his own opinion on the matter. I certainly have heard of doctors who are very keen on trying alternatives before prescribing medication. My understanding is that the current wisdom says that Cognitive Behavioral Therapy can be as effective as medication, and is often worth trying. The procedure in the HMO I currently have is that family doctors do not prescribe anti-depressents, but rather refer the patient to a psychiatrist. Only the psychiatrist is allowed to prescribe medication.
I have a question for you: You seem to be implying that your depression was very mild, and that you think you were hastily put on medication that you didn’t need. But I’m wondering, if it was really so mild, why did you need to go to a doctor in the first place?
My mum is a mental health social social worker, she thinks that doctors ‘hand out pills like sweets.’ She often has to fight to stop doctors putting her clients on unnecessary medication.
The difficulty that doctors face in the UK is that medication can be handed out immediately, whereas just about any other treatment involved a long waiting list - in my case, four months to see a staff-grade psychiatrist, six months for a counsillor and ten for CBT. If you need a psychoanalyst, psycho-geriatrician, or anything other specialist, forget it.
GPs know that these waits are intolerable for many people, and have to resort to prescriptions.
Short answer: yes, they are overdiagnosing it, and they are overprescribing antidepressants for it.
Long answer: You’ve got three factors converging here.
First off, psychiatry occupies two roles, only one of which is legitimately about what it claims to be about. (That would be the offering of mental health services to people who are suffering from cognitive and emotional symptoms). The other function (getting inconvenient and disturbing people out of other folks’ hair and off the streets without due process by pretending they are helping them) poisions the legitimate function, insofar as people within the profession believe their own profession’s claims and assertions, including those that are embraced for convenience and as pseudo-medical window dressing for coercive practices in institutions and with regards to involuntary commitment and so forth. If you’re not following all that, consider the Soviet Union, where dissenters were often declared to be “mentally ill” and committed to psych institutions. These dissenters were actually being punished, and their “treatment” was chosen in part for its unpleasantness, and their persistence in voicing criticism of the government was considered a “symptom”. When you’ve got that going on, when those assertions mingle with those drawn from careful laboratory research, you end up with a mishmosh of agenda-polluted theory and practice. Now, before you start wondering if I’m sporting the latest in tinfoil headwear fashion, I’m not saying political dissidents in the US are routinely incarcerated as they were in the Soviet Union — our illegitimate psychiatry mostly focuses on disturbing people and people who are inconvenient to the general public, not political dissidents. But the pollution of medical theory and practice works the same way. Private psychiatric outpatients are often given psych treatment that was first embraced on the locked ward for its efficacy in masking symptoms and making patients less disturbing to others, because the window dressing excuse for administering the treatment on the ward was that the treatment would fix their mental illness. And individuals receive psychiatric diagnoses such as “depressed” or “bipolar” or “schizophrenic” on the basis of a wide range of behaviors that were first described as symptoms of those ailments in order to find a wide range of inconvenient people “mentally ill” whenever it was useful to do so.
Second, doctors like to cure diseases and send people home healthy. Doctors in general do not appear to like it when they are confronted with things they can’t fix. So there’s a tendency to see people who seek counseling due to concerns about their life and how they feel about it as a type of nail (mental illness) because their tools are hammers (medications) rather than to say that your problems are things they can’t do anything about.
Thirdly, last and not least, while the pharmaceutical industry advertises and schmoozes and practically lobbies all kinds of doctors to write prescriptions for their new pills, this appears to be especially pervasive in the psychiatric discipline, where to an increasing degree many practitioners see their entire practice in terms of matching the person with the pill.
I think it probably is over-diagnosed, but the problem is that depression is difficult to define. You can’t exactly measure a person’s level of anxiety, the depth of their sadness, or the degree of hopelessness. Doctors are more afraid to miss someone who is really depressed, so they prescribe meds that aren’t particularly intense to cover their butts.
And another thing. We, as a society, are way too fucking impatient. When our lives are rocky for any length of time, we simply can’t stand the way it makes us feel and want it to go away. Often times, the bad feeling would go away in time anyway, but we don’t have the time or gumption to ride it out. We want to feel normal and we want it now. We confuse clinical depression with the blues. We treat everyday life situations as if they were earth-shattering cataclysmic events.
Sometimes it’s good to feel utterly despondent. When you lose someone you love, when your heart gets stomped on, etc., you need to work through the emotions. Yes, sometimes there is a serious need for medication and therapy, but mostly, I think if folks would stop being afraid of their emotions, they’d see how important it is to feel all those things they feel. It all builds upon itself to create multi-faceted people who are compassionate, loving, strong, brave…
Your particular case may be skewed precisely because of that extensive family history. Patient comes in whose entire immediate family and a fair amount of extended family have diagnosed depression with (presumably) good responses to antidepressent medication without adverse outcomes, and has symptoms compatable with depression … well, that family history does prime the pumps some.
As a general pediatrician I rarely prescribe antidepressents for depression, other than as a BandAid to bridge someone with a moderate or worse (but not potentially suicidal) depression over til they can get into see psych. Mild depression goes to the therapist (although coverage and cost is an issue). But boy with that story I could potentially have a parent twist my arm into it as a trial.
As to the general: yes, depression is a squishy label; yes, it is influenced by the fact that we docs love to fix problems and if we have a hammer that we believe works* and that has little risk for harm, well we are going to give it a swing sometimes; yes, Big Pharma is an incredible marketing machine dedicated to getting and keeping as many people on high profit margin long term meds as much as possible - the marketing hits on the general public and the docs in coordinated campaign convincing members of the public that do not need to be afraid of being in public crowds and parties if only they took a medication, and docs that such fear is a disease that deserves treatment that they can conviently offer.
*The caveat is that the evidence for this hammer’s efficacy isn’t as good as many of us docs think it is. Which doesn’t mean that it doesn’t work but does mean that it very hard to screen out placebo effects in this particular illness.
I dunno - I think you guys are being hasty, at least with regard to the U.S. The OP said he went to a doctor for depression, the doctor prescribed Prozac, the Prozac didn’t word, and he was referred to a psychiatrist. I don’t see that this was necessarily a misdiagnosis. He says the Prozac “didn’t work.” Well, it doesn’t always work. It’s not magic.
I keep hearing people say that medication is over-prescribed in the U.S., but I never hear any reasonable evidence of it. You can’t do a blood-test for depression; it’s basically up to the doctor to determine from talking to the patient. No doctor worth his salt is going to prescribe Prozac for a girl who’s a little bit sad because she broke up with her boyfriend, for example. If they’re doing that, then they’re idiots. Likewise if they’re not discussing the alternatives with the patient. I’m just not seeing the evidence that this is such an entrenched part of medical practice in the U.S. For example, DSeid just said he/she rarely prescribes antidepressants.
The reason why I agreed to go to the Doctor was because I was crying about twice a week, my grades were in the crapper, and I was sleeping too often. It had in part to do with a failing relationship, and the fact that I’ve always been rather sensitive person. My mother, who is also on anti-depressants, saw in me the same symptoms that she used to have, and urged me, but not in a coercive manner, to go to the doctor. So, I did. In hindsight, my motivation to go was probably more in order to placate my mother, rather than a willingness on my part. I was, and still am, not very gung-ho on medication as a solution to my depression.
I’ve been on Lexapro now for about a year, and though I don’t feel it has “worked” in the sense that it is meant to, I do feel I am no longer depressed. However, I’m inclined to say it was the healing nature of time and maturity, rather than the medication which caused my condition to improve. Of course, it’s difficult to say.
Also, in response to blowero, I’m aware that it’s usually difficult to find an anti-depressant, and even a dosage, that works for each individual. When I said the Prozac didn’t work, I was simply stating what happened. The pediatric doctor felt that it would be better if I saw a psychiatrist.
I ought to have mentioned this in the OP, but what bothered me most about the visit to the first doctor was that all I had to do was answer a short, verbal questionaire, and literally about 5 minutes later I had a perscription for Prozac. Again, as I don’t know about others experiences, this could be due to the fact that much of my family is on anti-depressants, but I was a little surprised that the diagnosis wasn’t a little more rigourous.
Is there some fatastic streak that makes clinicians think everyone who is the child of depressives/ people with bipolar disorder (one parent of each in my family) are going to fall prey to the same thing? I’ve never even talked to my mother’s doctor- beyond saying hello when she comes to get my mother from the waiting room- and she tells my mother that I should " see someone, just in case" given our family history. sheesh. My response, which was relayed to her :smack: was that I don’t appriciate medical advice from someone I’ve never even spoke to, thank you. Now she doesn’t make suggestions like that any more
Humph, you should see how they are if you have a history of psychiatric diagnosis! If you’ve ever been diagnosed with “depression”, “bipolar disorder”, “schizophrenia”, etc., no doctor is ever going to attribute your symptoms to ordinary stress, relationship failure, problems on the job, etc., nor are they likely to test for nutritional probs, brain tumor, thyroid probs, cardiac mitral valve induced panic disorder, medication interaction induced psychosis, etc etc. Nope, previous doctors have found that you suffer from depression, you’re miserable now, it’s cuz you’re a depressive.
That was kind of my point. I’m not a doctor, of course, but to me those symptoms do sound like mild depression, so I don’t think it’s fair to say you were misdiagnosed. I have battled depression at various times in my life, and only recently did I find out that several members of my immediate family have as well, and never told me! It IS an important consideration, because it DOES tend to be hereditary. I wish that my family had encouraged me to seek medical advice when I was young. I ended up having to do it on my own when I was an adult.
But I do agree with your point that it would be better for family doctors to refer patients to a specialist rather than just putting them on medication. And here’s some free advice: Don’t let anybody else tell you what’s right for you. You’re the only one who knows that. If you don’t want to take medication, and prefer to try therapy, then you should be able to do that. It’s your life, and it should be your decision. Sometimes you have to be assertive. I had a similarly bad experience to yours with Prozac. I tried it, and I felt like my head was going to explode. My doctor said I should stick with it, but I insisted we try something else. He prescribed Zoloft, and that happened to be the ticket for me. It worked very well, got me over that hump, and now I’m completely off medication and doing well. There’s a reason they have different medications - they aren’t all exactly the same.
I know you’ve had a horrible history in this regard, but I don’t think you can generalize this to all doctors. It’s certainly not true of the doctors that I have trained with, and I like to think it isn’t true of me.
Oh, and no, I don’t test for “cardiac mitral valve induced panic disorder”, and I won’t until I see some convincing evidence that there is an actual causative association between MVP and panic attacks, and if there is such an agent, whether it would change management of them.
As for the OP–what you mean by “overdiagnosing depression” is actually “overprescribing antidepressants”, and hell yes, we do that. These are drugs for which the side effects are usually mild and nearly always self-limited, so there is very little harm in an empiric trial of an SSRI in anyone you feel might benefit from it. Those who benefit? Great. Those who don’t? Well, we tried. They stop taking it and we try something else.
If a drug offers a potential benefit and very little risk, it is better to have it and not need it than to need it and not have it. In this case, we should be overprescribing, being careful to follow up (it’s no good to just put everybody on it if you’re not being careful to take them off if it doensn’t work).
Thank you everyone for all your responses, especially you Doctors.
I have a few thoughts to add to the discussion:
If doctors are overprescribing anti-depressants to patients with mild depression, isn’t this doing them a disservice in the long run? That is, if anti-depressants are readily available for people that don’t truely need them, won’t they become more reliant on AD’s to overcome a depression, and less likely to grow and mature emotionally in order to solve their problems?
Obviously, there are some flaws in the reasoning above, because there is the issue of determining who “deserves” AD’s and who doesn’t, etc. But I find that I am more or less am inclined to believe it.
Also, I should mention, for those of us who have less than magnificant health insurance, paying for needless anti-depressants can be a burden.
I may be wrong, but I don’t believe depression is caused by emotional immaturity. I think that’s exactly the stigma that needs to be overcome, that depressed people are somehow responsible for their own condition because they aren’t “tough enough”, or are being “overly sensitive”, or just need to “suck it up”. I haven’t heard any evidence that antidepressants ever prevent people from making a recovery.
Have you considered the possibility that you might be somewhat in denial about your condition? Maybe you’re afraid that if you go on medication it will “prove” that you are depressed, and you don’t want to admit that you are?
But certainly there has to be some sort of dividing line, or degrees anyway, between someone who is clinically depressed and someone who is going through a temporary depression (months to a year). For these people in a temporary depression, isn’t a little suffering good? Isn’t that how we grow as individuals?
Blowero, you say:
I’ve been on medication for a year, and now I feel like I don’t need it. Like I said earlier, I’m not sure if this is because the Lexapro worked or because I’ve matured over time.
“A little suffering” to me means, down in the dumps for a couple days. “Months to a year”? Why on earth should anybody have to suffer for such a period of time? How will that help them grow as individuals, it seems to me to be more likely to have the opposite effect.
Counter example: I’m prone to headaches. They aren’t migraines, they aren’t completely disabling, but they still interfere with my enjoyment of life. I might ignore them when they last a day or two, but if I was waking up every morning for months with them I would medicate them and virtually nobody would tell me I shouldn’t do. Why is it any different with depression?
I’m no fan of psychiatric meds, but no, taking them isn’t akin to “coddling your emotions” and making you “emotionally weak” or something.
blowero:
I have. Varies from person to person, but as with most psych meds, antidepressants can cause iatrogenic mental problems, which can most certainly prevent people from making a recovery.
I listed it as an example of how behavior that could be interpreted as psychiatric symptoms, symptoms which can and have landed people a psychiatric diagnosis, may actually be symptoms of cardiac / autonomic nervous system problems.
