Depression and whether a behavioral problem is mental illness

It has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.

The number of Americans prescribed an antidepressant doubled between 1996 and 2005 and those being treated took more tablets. Yet there is nothing to show that the population is better off. In fact the suicide rate has risen.

It is interesting to note that $1 billion is spent each year on promoting anti depressants. Between 1999 and 2005 the amount spent on direct to consumer advertising nearly quadrupled.

When one looks at the definition of depression in the DSM4 (the psychiatry reference manual) there are a number of criteria, which need to meet for a diagnosis of depression. Some, like a 5% change in weight are measurable; others like reduced concentration are subjective. There are nine criteria of which five need to be present for at least two weeks. There needs to be an impact on the person’s ability to function either at work or socially.

This area is a touchy one. Many people feel bad, feel stressed or have issues that trouble them. These people may need assistance to get through a difficult time. There is a tendency to label many of this group as being depressed. The rise in prescriptions in part represents a reclassification of stress as depression. The two may overlap but are not the same.

The de-stigmatizing of mental health has been a good thing. Mental health issues are no less real than any other. However, it has also led people to feel that having a bad hair day is somehow the same as having depression. I am staggered by the number of people who feel that because they are facing challenges in their life; feel that they have got “a bit of depression”.

When “bad” things happen it is as normal to feel down, as it is to feel happy when “good” things happen. To feel down after a relationship breakdown or job loss is no more abnormal than to feel happy after winning a lottery. There is a range of human emotion and feeling-all of which are valid.

We need to be careful about medicalizing the human condition. Claims that three year olds can have depression demonstrate this tendency.  Children, like adults can have emotional and behavioral problems and those problems need help. This is not the same as saying they have a medical illness requiring a drug.

It was Sigmund Freud, no less who in 1926 warned that if psychoanalysis fell into the hands of doctors that the human psyche and its nuances would be reduced to an illness to be treated. I suspect if he were alive today he would be horrified at how pharmacology now dominates the field of psychiatry.

Without the dark we could not understand light. We all have lessons to learn in our lives. It is from the hardest times that the greatest growth and learning’s come. Some people will need medication to get them through or at least started. For a reasonable number of people who are experiencing life’s “downs” the answer is more likely to lie in confronting and resolving the issues rather than in a tablet.

Joe Kosterich is a physician in Australia who blogs at Dr. Joe Today.

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