Arguably, the answer to the question in the title is, the 1980s. Yes, it was during the eighties that a certain tinkering took place with the symptoms for clinical depression and this resulted in a situation where people who felt sad and down for a couple of weeks, enough that it affected their appetite and sleep habits, could be considered depressed. Now you might be thinking, hold on, I would have thought these symptoms are perfectly normal in the right circumstances. And of course you’d be right, but let’s put things into some kind of context, starting with the 1960s
During the 1960s there was no real sense of just how common depression was, and neither was it defined in the same way it is today. The range of antidepressant drugs and their relative sophistication was limited, but by the time we reach the 1980s depression has quite literally become big business. Prozac is made available in the late 80s and doctors are advised to become far more sensitive to the symptoms of depression in their patients. Subsequently, as the historian of psychiatry Edward Shorter put it “the boundaries of what constitutes depression have been expanded relentlessly outward. Depression in the vocabulary of post 1960s American psychiatry has become tantamount to dysphoria, meaning unhappiness, in combination with loss of appetite and difficulty sleeping.”
Fast forward to 2014 and what have we learned from this? Perhaps not a great deal according to professor Chris Dowrick an academic and family doctor. Writing in the British Medical Journal, Dr. Dowrick suggests that over diagnosis of depression is commonplace and that antidepressants are being prescribed for simple sadness, sexual problems, inability to sleep well and bereavement.
According to Dr. Dowrick action needs to be taken on two fronts. Drug companies should be stopped from marketing antidepressant medications to physicians, he says, and promoting the use of antidepressants for mild depression and anxiety. In the UK alone, sales of antidepressants have been climbing at a rate of 10 percent a year, despite the fact that antidepressant medication is known to be ineffective in cases of mild depression. Secondly, a tightening of the guidelines on diagnosing depression is needed, he says.
It’s a difficult circle to square. We know that depression is currently ranked at number two as a global cause of disability and we know that it remains something of a hidden disease. There are accusations that some doctors remain insensitive to the symptoms of depression and others are treating all manner of emotional and social issues with antidepressants, perhaps because it’s all they have to offer? So on the one hand depression is a big public health challenge, a silent epidemic, and one that most experts agree isn’t being properly addressed. According to the World Health Organization developing countries spend less than 2 percent of their budgets on mental healthcare in total. Perhaps faced with a lack of direction and fully disclosed information as to the pharmaceutical effects of antidepressants our family doctors do what they feel is in their patients best interests. Is it better to be over-diagnosed or under-diagnosed? Actually, the answer is surely to be accurately diagnosed. But it seems we have some way to go in this regard.
Published On: January 06, 2014