Psychiatrists debate ‘over-diagnosis’ of depression

Two leading psychiatrists writing in the British Medical Journal have sparked a debate over whether too many people are being diagnosed with depression.

Professor Gordon Parker of the University of New South Wales in Australia argues that the threshold for clinical depression is too low and that many people being prescribed anti-depressants are not really depressed, just unhappy.

Professor Parker called depression a ‘catch-all’ diagnosis driven by clever marketing that supports a thriving prescription drug industry and said ‘over-diagnosis’ of depression could lead to normal emotional states being treated as an illness.

But Professor Ian Hickie, executive director of the Brain and Mind Research Institute at Sydney University, writing in the same issue of the BMJ, said: “The real harm comes from not receiving a diagnosis or treatment when you have a life-threatening condition like depression.

“Large GP-based audits in the UK, Australia, and New Zealand do not support the notion that depression is now over-diagnosed or treated exclusively with anti-depressants.”

Professor Hickie claimed that increased diagnosis of depression has resulted in lower rates of suicide and encouraged a more understanding public attitude to mental illness.

The debate has been taken up by mental health experts in the UK and Dr Andrew McCulloch, chief executive of the Mental Health Foundation said it was ‘very unlikely’ that depression was over-diagnosed in the UK.

He said it was more the case that many people did not seek help because they did not recognise the symptoms of depression.

However, he also agreed that doctors were too readily providing medication when alternative treatments could be more effective.

“Medication is relied upon heavily in the UK by GPs and patients, and is often
prescribed when an alternative might have been more suitable,” he said.

The World Health Organisation predicts that, by 2020, depression will be the second most serious disease globally after chronic heart disease.