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.

I agree Mitchy - if resources I.e. drugs are being given to people who will not benefit as their issues are not medical, it is a waste of resources.

Hackmum - there are two sorts of tests and there are ways that you can tell if someone is depressed by how they look, speak, eye contact, ways they express emotion. Really, it is difficult to fake.

it seems to be about the severity of the depression, drugs are apparently most help in moderate to severe cases but the net they use now is scooping up milder incidences which might be self-limiting (just clear up by themselves) and so GPs should be directed to prescribe only for those more serious depressions or where normal bereavement is complicated, for example

I completely agree mitchy - lots of people can have a period of feeling a bit crappy. When its true depression, I just think crack out the drugs and all the therapies we can so people don't suffer.

If people are "depressed" because their boyfriend dumped them, then that's a normal life event so "on your way" IMHO.

but somewhere between those examples must be quite a lot of people who need something more than 'on your way' but for whom antidepressant therapy would not be helpful

I really didn't want to invalidate how difficult life is for people who are sort of functional and depressed, I just think we should have something better to offer than 1. drugs that not only probably won't work but might even possibly induce depression 2. telling them they are sick when actually life is just cruel and unfair to them

somehow it manages to make it both the individual's 'fault' (faulty neurochemicals, faulty coping styles, faulty thinking, faulty genes) and simultaneously not their fault (you can't help it, you're not well)

But the chances are, for those who really need them, the drugs will work rather than induce depression. They really do in most cases of genuine depression which is moderate upwards. People who are functional and depressed still need medication because they would probably be moderately depressed. "Help my boyfriend dumped me" is mild depression/ down in the dumps stuff.

And there is middle of the road stuff e.g. On-line CBT.

If people are presenting as depressed, then I say give the drugs first and dig deeper when they're showing signs of recovery. I have no idea what the statistical success rate is for talking therapies curing clinical depression, but even if they are very successful, they take time.

Why leave somebody ill when we can offer them a quicker way to recover. Why should mental illness not be given a 'quick fix' - we want to cure all other illnesses as quickly as we can.

I'm very grateful for the current easy availability of ssri medication, as it saved my life and gave me back to my family. I feel that it is patronising to suggest that people shouldn't be given pills that would make them feel better when we can make them work harder for a cure.

Poverty has always been with us. Material lifestyles are getting better all the time, our general standard of living has never been better. If people are depressed because of poverty, then the first thing to do is treat the patient. Looking at solving poverty comes later, and to my knowledge it hasn't been solved in any country or time in history so we may have a long wait.

it's terrible

admittedly I have a mild axe to grind against antidepressants because they made me so unwell and set off a chain of hospitalisations etc which am not sure I will ever forgive - but perhaps I was a ticking time bomb anyway

but the situation as a whole is quite depressing in itself, when CBT emerged as a promising treatment it was an actual personalised treatment tailored to the patient - not some phone or online thing that says nothing about what individuals are actually experiencing, it continues to underline and emphasise the idea that it is the person who is broken or somehow wrong, rather than acknowledging how unjust everything is or actually helping them

morris - I think the point of the original paper was that the antidepressants were and are being prescribed for situations where there is no evidence they will help, and possibly even make things worse

not that people who seem likely to benefit from them shouldn't have them, but that there is no evidence for their role in treating milder depression or the range of everyday miseries that can be diagnosed as depression now

I can easily believe it's over-diagnosed.
On MN, People who are upset about cruddy stuff going on in their lives are always being told they must be depressed. It drives me a bit batty. You've a right to be down when heaps of things are cruddy in your life. It's a very rational response.

"On MN, People who are upset about cruddy stuff going on in their lives are always being told they must be depressed."

Because an MN diagnosis means that Gps must diagnose the same way?

you can see how it works though, everything is shit and feels unbearable, you get your (on average) 11 minutes with a GP, what are they supposed to do? people going through hard times or leading unspeakably bleak lives need and deserve some validation and support whether their depression is the kind that is likely to respond to antidepressants or not

I think once upon a time it was believed that antidepressants could help milder depressions so is partly about our knowledge and understanding improving now

There's a reason why one in 6 people Blackpool are on anti-depressants. Blackpool has been used as a dumping ground for people with social problems who were homeless and entitled to social housing for years and years.

One of the main criteria which makes people eligible for social housing is health problems, especially mental health problems so it would be more surprising if a significant number of people weren't on anti-depressants in Blackpool.

To be honest having suffered lifelong depression which only responds to drugs myself I would be much more concerned about it being under diagnosed. Mental health services are already chronically underfunded and it's hugely difficult to get help.

I would rather a few people were given them for a few months when they didn't need them than people were turned away when they were genuinely depressed. I think that's the problem, if there wasn't some overdiagnosing to be on the safe side people who were genuinely ill would be being turned away.

We'd be in a situation where people would have to be literally slitting their wrists, had already lost their jobs and had been forced into much more bleak desperate situations before they got help. Not to mention the people who would probably kill themselves before they got it.

does it have to be one or the other though? people being turned away when genuinely depressed or people being medicated when it's not indicated

I think part of the wider point is the nature of what we have come to understand as 'genuine depression' though, and that people are not just taking them for a few months and that they are not some sort of harmless, entirely benign intervention but they carry risks of side effects, discontinuation troubles and so on

When CBT emerged as a promising treatment it was an actual personalised treatment tailored to the patient - not some phone or online thing that says nothing about what individuals are actually experiencing, it continues to underline and emphasise the idea that it is the person who is broken or somehow wrong, rather than acknowledging how unjust everything is or actually helping them

This really struck a chord with me, Mitchy. I have Generalised Anxiety Disorder and have never found CBT useful, despite being told it was an excellent treatment. It seemed to me to boil down to being told to believe that everything is OK, when the very problem is you can't believe that.

Do you or Hairy have any experience of mindfulness based therapy as treatment? I was working through a mindfulness book, feeling good about it but got out of the habit of meditating and have gone downhill badly.

Over-medication is a massive problem, as anti-depressants themselves have side effects and the evidence shows they are not effective for mild depression anyway, only the more severe kinds.

I suppose the difficulty is that GPs are time-constrained and can't really tell a severe case from a more milder one, especially if the person is distressed and so may err on the side of caution, especially given waiting lists for talking therapies.

If you saw me you'd probably think I was just a normal person. I get up, go to work, come home. I can function. However inside I'm just waiting to die. The only thing I get comfort from is planning my death. I have lots of methods worked out and I keep trying them.

Last time I had to have wounds stitched and have charcoal in A & E. I was admitted to a medical ward. My only contact with the Mental Health Team was a junior doctor from psychiatry who told me I wouldn't be so silly again and that was that. If I ring the crisis team they tell me to flush my medication down the loo so I'm not tempted to take it. I bloody want to take it.

I had 'guided self-help CBT' from a 'graduate' mental health worker. That is it. It was crap because I am the terrible horrible failure I know myself to be, so why would I believe I'm not? I won't lie to myself.

Without the antidepressents I doubt I'd be able to function. I don't live, I function. Depression isn't feeling a bit sad. It is fucking crushing, it is everything, it takes over it magnifies every little failure. I wouldn't wish it on my worst enemy.

I also think, though that the health-service is remarkably reluctant to restructure itself to the reality of who presents at the GPs surgery. Given so many people go in for MH issues, they could have a specialist in the surgery, or a designated GP to see who actually knows more about MH issues and is up to date. One of the problems is that seeing a GP is a lottery and most are not that clued up about MH issues, plus MH funding is very scarce, not enough resources, so there's a general issuing of ADs on the front line to cope with the masses, but only those who are very ill then get specialist treatment.

I live near Blackpool. I'm surprised that figures not higher tbh

Claudius I'm sad to read your post, you are exactly who I am thinking of when I say there should be much more help, specialist help, for people whose lives are dominated by MH (not just depression). There is almost nothing out there, you have to be extreme and severe, and even then there is no follow up. I'm glad the AD's help to some extent.

one of my (bipolar) friends is tremendously impressed by mindfulness, she did some sort of course (I don't remember who ran it, I'll find out) and still does it daily and it is helping now, when she has even worse things to cope with

on the other hand I know two people who have taken part in an IAPT mindfulness group and it sounded fucking dire, a man pretty much reading stuff from slides with an overhead projector - it would be funny if it wasn't a case of they HAVE to do this course before they can be considered eligible for any other sort of help, even if it means paying a babysitter for a few hours a week and sitting through this crap

but am sure it varies and maybe it's like CBT, if it's done properly it might actually help

sorry that was to profundorosso

Thanks Mitchy, that second course doesn't sound good, but I'm glad your friend is doing well.

Horatia antidepressants aren't "happy pills". They bring people back to a normal level that people without depression experience already.