to think the over-diagnosis of depression is hardly news?

[Mitchy1nge]

in torygraph today it's claimed depression is more likely to be over than under diagnosed - something this blogger describes as social suffering apparently something like one in six people in Blackpool are on anti-depressants

is this only in the news this week because everyone is supposed to feel a bit crap in January? The study came out a few weeks ago.

CAMHS doesn't seem to even exist here at the moment but that's another thread I can't face starting just yet

Well, the ICD is more encompassing than the DSM's definition.

Punkatheart - that sounds dreadful and can't believe they are still not rushing her through the system, especially if they think its organic. Have you got in touch with the Patient Advice and Liaison service. Complaints to them seem to have the power to speed things up!

"Unfortunately, instead of addressing the societal problems, the person is medicated so the symptom is treated rather than the cause."

it is horrible to make it the individual's problem rather than trying to address the inequalities, I think the blogger is making that point

Any deviation from being happy is seen as abnormal health....

Completely disagree Piscivorus. I've discharged patients from actute mental health wards as their issues were about circumstance. I've made appropriate referrals to social agencies first, but ultimately you cannot medicate a crap social situation and most mental health services know that.

If the GPs are giving out meds in these circumstances, than shame on them.

I waited 15 months for CBT for panic attacks. If I had been able to be treated sooner I might have avoided the medication. The thought of another panic attack made me want to drive into a brick wall, hence why I took the meds

No wonder people are depressed. I myself am stuck in a job I hate. I have been looking for another job for a year now with no luck. I'd like to move house (renting in a dump) but my low wages don't allow me to save up in order to move. I'm on antidepressants to help me to get out of bed in a morning.

I thought it was quite interesting that the rise in prescriptions for antidepressants wasn't because of new cases being diagnosed so much as existing patients staying on them for longer and longer though - and that the drugs themselves are responsible for this new chronicity of the condition, if that makes sense.

Don't blame you Goodasitgets. Panic attacks are bloody awful.

Mitchy - how do the drugs themselves make the situation chronic? I don't understand.

did you read the article hairy? it is skimpy to say the least on that, refers to the dubious 'tardive dsyphoria syndrome' - would like to read more on that

Is it over diagnosis though? I'm convinced social circumstances can cause clinical depression.

tardive dysphoria syndrome

"so much as existing patients staying on them for longer and longer though - and that the drugs themselves are responsible for this new chronicity of the condition, if that makes sense."

It doesn't. I suspect people are on them for longer as mental health services are being cut, so more people are left with only the pills to help, hence why they are on them for longer. I've never heard of anti-d's prolonging depression.

Hairy I think GPs are giving out meds in those circumstances, not because they are crap or irresponsible, but because they have a distressed patient, often waiting long times for referrals who expect them to do something. I think the situation in Mental Health is very different to that in Primary Care.

Ah OK, seems it's more that long term anti depressant use can cause them to be less effective. So more that people build up resistance rather than the anti depressants making the condition chronic. DH has recently been diagnosed with treatment resistant depression, so had heard a little about this.

I think tardive dysphoria sounds a bit dodgy but they definitely seem to think it induces depression rather than stops working against it - there is was already that 'prozac poop out' thing, do you remember that?

Speaking as one who has been depressed on and off for decades I do think there is a difference between non-reactive depression and the misery caused by deprivation (and I don't mean everyday feelings of one off unhappiness). I believe that there is a tendency to medicalise the latter because if you individualise it into an illness that person is suffering from then there is less need for wider society to do something concrete to fight poverty. It's up to the individual to seek pills/talking therapy when what they need is a good job, a warm community, a safe home and some cash.

But whilst this approach is being taken then I wish that mental health services were adequately funded and staffed to cope with the demand. It is a huge fight to access help if the pills and the first course of counselling/CBT aren't of any use. It is worth going back and badgering the GP for more help though, if you have the strength. Whatever type of depression people have, I wish them all the best.

as they say "This is an emerging evidence that, in some individuals, persistent use of antidepressants may be prodepressant." but this could be a load of shit of course, more research urgently needed and all that

Just skimmed it now. I have never done a random trial in my patients, but I honestly don't think I've ever seen anti-depressants cause depression.

I've seen them not work because either the person's biochemistry does not respond to that particular drug, so then we try another. I've also seen them not work because the issues a person has are more to do with social circumstance or personality, and no tablet can change those.

Also, weirdly, sometimes they just stop working and so we have to find another one that does work. But that doesn't mean that the depression is not there, just that the meds don't work anymore (ooh, I sound like the Verve!).

Honestly, when you have to prep someone for ECT because their life is at risk due to them being catatonic with depression, you really cannot ever mistake it again for feeling down in the dumps. At it worst, depression leaves a person with no feelings whatsoever, so if someone is a tearful mess due to it, I always think at least they are not at rock bottom yet.

Sorry for the epic post.

They do just stop working. It's as if you build up a resistance and then you try another. I remember my doctor saying "Don't worry, there's loads we can try" when I worried about 'running out' of options. I haven't heard of them causing depression though - it's more that the pills deal with the symptom but not the underlying cause because no-one knows yet what the cause is.

" you really cannot ever mistake it again for feeling down in the dumps"

Very true.

"I think GPs are giving out meds in those circumstances, not because they are crap or irresponsible, but because they have a distressed patient, often waiting long times for referrals who expect them to do something."

Also a fair point. I know from my gp that it is hard for them to get help for the patients, and we are in one of the "lucky" areas with a CMHT.

but the original paper from December last year (so not sure why in the news today ) argues that people who will not benefit from antidepressants are being prescribed them, and provides evidence of overdiagnosis - and many harms flow from that, for the individual who is not getting appropriate support and for us all as clinical energy and other resources are diverted from problems they could be tackling

so it is worth thinking about at least

It is a fair point that the patient expects them to do something, but any GP who prescribes medication for an illness which they do not think is actually present in the patient, is in fact irresponsible.

LaGuardia - not IME.
I've been given pills and told to exercise outdoors, but never, ever signed off, even when the depression has been fairly extreme.

In my case, however, what I really needed (as well as, probably, a talking therapy) was direction towards support groups for carers as what I was experiencing was exhaustion - I did disclose my situation to the GP, who was well-meaning but quite clueless. Lack of MH provision in my area is almost certainly a lot to do with it. It's a great place for back injury treatment though...

Well, the problem is that depression isn't something you can test for - you have to rely entirely on a person's own account of how they're feeling. Or rather, your perception of their own account of how they're feeling. Some people can be inwardly depressed but appear cheerful. Others, presumably, can fake depressed feelings. So if you're a GP, what are you to do? In most cases, you won't be able to refer instantly for CBT or other therapy. A prescription for anti-depressants may be the most straightforward and simple solution.