An epidemic of depression?

Psychiatric News has a thought-provoking article criticising the current definition of major depression, suggesting that it has lead to normal sadness being diagnosed as a serious mental illness.

The authors give an abbreviated version of the argument they make in their book The Loss of Sadness: How Psychiatry Transformed Normal Misery Into Depressive Disorder.

They argue that the diagnosis contains no qualifications about whether the reaction is appropriate in the context of the person’s life, meaning that people who have suffered unemployment, relationship break up or other forms of personal tragedy are considered equally as ‘mentally ill’ as people who have similar mood disturbances but without a specific trigger.

Ample scientific evidence—ranging from infant and primate studies to cross-cultural studies of emotion—suggests that intense sadness in response to a variety of situations is a normal, biologically designed human response. Recent epidemiological analysis suggests that the consequences of stressors can be either normal or abnormal, similar to those for bereavement.1 In its quest for reliability via symptom-based definitions that minimized concern with the context in which the symptoms appeared, DSM unintentionally abandoned the well-recognized, scientifically supported, indeed commonsensical distinction between normal sadness and depressive disorder.

The blurring of the distinction between normal intense sadness and depressive disorder has arguably had some salutary effects. For example, it has reduced the stigma of depression and created a cultural climate that is more accepting of seeking treatment for mental illness. Many people with normal sadness might benefit from medication that ameliorates their symptoms. However, the usefulness of medication for normal sadness, and especially the trade-off between symptom reduction and adverse effects, has not been carefully studied—partly because the necessary distinctions do not exist within the current diagnostic system.

One of the most worrying effects of this trend has been a boom in the prescription of antidepressant medication and quotes the worrying figures that “Roughly 10% of women and 4% of men in the United States take antidepressant medication at any time. By 2000, antidepressants were the best-selling prescription drugs of any type”.

The debate over whether depression is being over-diagnosed hit the pages of the British Medical Journal last year with the both pro and anti positions being argued with full force.

Link to PsychiatricTimes article ‘An epidemic of depression’.

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