I have been doing medical transcription for family practice for the last few years, and I know what doctors diagnose, perhaps more than anyone else other than the doctors themselves, and I have been wondering lately if depression is over diagnosed in family practice settings.

Doctors, understandably, seem to have a "fix it" mentality and when there exists a lack of objective findings, it is so "convenient" for doctors to hand out antidepressants. Am I right about this? It happened to myself as well. I am a 28-year-old female who recently recovered from a more than 2-year-long febrile illness with fatigue, anorexia, and weight loss (down to 87 lbs at one point)--no objective findings. So a doc gave me samples of Lexapro. I don't agree with that practice! Am I the only one?

It seems that they become "comfortable" with the proposed safety of antidepressants that they feel they can just hand them out like candy. In fact, I typed a report rather recently of a case where Paxil was given to a 12 year old!! Last I knew the FDA had not approved Paxil for use in children. Am I correct? So, why are these issues coming up? I really do not think that diagnosing and treating depression in such a light manner is very wise.

One more thing to think about: Is it also possible that physicians often confuse normal sadness and emotions or "emotional expression" with pathological depression or anxiety?? If I happen to tell a doctor that I have been "feeling depressed lately" along with whatever other symptoms I may be experiencing (could be about anything) I guarantee he/she will offer an antidepressant. Is that right? It is normal for everyone to "feel" depressed sometimes. One pt on an SSRI said that she had been "unable to cry" since she had been on the drug and was pleased, so the doc kept her on it. What?? I certainly don't want to be on anything that might deprive me of my God-given ability to cry and feel sad. Sorry, I don't think that should be the goal at all. I believe that pathological depression and "feeling sad" or "feeling depressed" are two different things, and a lot of family practitioners don't seem to realize the difference or care. Is it a coincidence that more women are diagnosed with depression/anxiety than men? Or could it be that women are the ones more likely to be emotionally expressive, and that just doesn't fly in the modern American corporate world, so we must synthetically repress such things? I am actually starting to think that true pathological depression is a lot more rare than one might think. There is a difference between depression that controls our lives and drives one to suicide and the ability and wonder of feeling sadness, depression, or even anxiety. Anyone agree?

I have been doing medical transcription for family practice for the last few years, and I know what doctors diagnose, perhaps more than anyone else other than the doctors themselves, and I have been wondering lately if depression is over diagnosed in family practice settings.

Doctors, understandably, seem to have a "fix it" mentality and when there exists a lack of objective findings, it is so "convenient" for doctors to hand out antidepressants. Am I right about this? It happened to myself as well. I am a 28-year-old female who recently recovered from a more than 2-year-long febrile illness with fatigue, anorexia, and weight loss (down to 87 lbs at one point)--no objective findings. So a doc gave me samples of Lexapro. I don't agree with that practice! Am I the only one?

It seems that they become "comfortable" with the proposed safety of antidepressants that they feel they can just hand them out like candy. In fact, I typed a report rather recently of a case where Paxil was given to a 12 year old!! Last I knew the FDA had not approved Paxil for use in children. Am I correct? So, why are these issues coming up? I really do not think that diagnosing and treating depression in such a light manner is very wise.

One more thing to think about: Is it also possible that physicians often confuse normal sadness and emotions or "emotional expression" with pathological depression or anxiety?? If I happen to tell a doctor that I have been "feeling depressed lately" along with whatever other symptoms I may be experiencing (could be about anything) I guarantee he/she will offer an antidepressant. Is that right? It is normal for everyone to "feel" depressed sometimes. One pt on an SSRI said that she had been "unable to cry" since she had been on the drug and was pleased, so the doc kept her on it. What?? I certainly don't want to be on anything that might deprive me of my God-given ability to cry and feel sad. Sorry, I don't think that should be the goal at all. I believe that pathological depression and "feeling sad" or "feeling depressed" are two different things, and a lot of family practitioners don't seem to realize the difference or care. Is it a coincidence that more women are diagnosed with depression/anxiety than men? Or could it be that women are the ones more likely to be emotionally expressive, and that just doesn't fly in the modern American corporate world, so we must synthetically repress such things? I am actually starting to think that true pathological depression is a lot more rare than one might think. There is a difference between depression that controls our lives and drives one to suicide and the ability and wonder of feeling sadness, depression, or even anxiety. Anyone agree?
i see what you are saying, and I agree that antidepressants seem to be handed out quite frequently, but yes, GPs are definitely qualified to diagnose depression, and they are just as qualified to hand out anti-depressants.

I do disagree in you thinking depression is overdiagnosed (well, you didn't say that, but you implied it). Depression, in fact, is greatly UNDERdiagnosed and it is a lot more prevalent in the population than you think. There are many more things to the diagnosis of depression than just a really crappy mood that has someone wanting to commit suicide. That's one extreme end of the spectrum. There are other examples of depression which can be something as simple as a 21 year old guy not eating.

Things that are characteristics of depression include:

depressed mood
psychomotor agitation or depression
anxiety
loss of appetite
oversleeping or undersleeping
loss of interest in previously enjoyed activities (anhedonia)
thoughts of, or attempts at suicide
inappropriate guilt
etc. etc. etc.

So as you can see, depression can take on many forms. The problem with it is that a lot of people would rather find some other explanation for their symptoms because they don't want to be labelled as a psych patient. There is unfortunately still a stigma in our society when it comes to psych problems.

BTW, about the 12 year old child being prescribed an SSRI....you're right, the FDA hasn't approved it yet, and a recent study in a British Medical journal mentioned that SSRIs shouldn't be prescribed to children under the age of 18, there is much observational data that SSRIs can be used in certain isolated cases with success.

Oh..and ANOTHER BTW, what did your febrile illness end up being?

The only FDA approved SSRI for people under 18 is fluoxetine (Prozac). I'm not sure exactly why, but the other SSRIs have been found to put people under 18 at a greater risk for suicide.

Depression isn't overdiagnosed, but some people with very mild depression are being treated more aggressively than people with more severe depression. Sometimes, however, other related mental illnesses are overdiagnosed -- e.g. when a doctor can't find an organic cause to someone's symptoms, they'll automatically attribute it to depression, anxiety, or hysterical neurosis (conversion).

One thing you mentioned, though, is that women are more frequently diagnosed with depression. That's true, but I think that's because women are more expressive and open with their symptoms than men; men may not show their symptoms as readily. That's what I think anyway, it might not be right.

The only FDA approved SSRI for people under 18 is fluoxetine (Prozac). I'm not sure exactly why, but the other SSRIs have been found to put people under 18 at a greater risk for suicide.
Yeah! That was published in the New England Journal of Medicine just about 6 months ago! Scary eh?
Sometimes, however, other related mental illnesses are overdiagnosed -- e.g. when a doctor can't find an organic cause to someone's symptoms, they'll automatically attribute it to depression, anxiety, or hysterical neurosis (conversion).
Conversion is a very rare diagnosis, and it's not made very often. Plus, hysterical neurosis is a bit of an antiquated term which has gone to the wayside along with terms like: psychogenic, monster, internal mammary artery, insanity etc. etc. Interestingly enough, though, the term for any gastrointestinal infection caused by anal sex of any form is STILL called Gay Bowel Disease--go figure! :) In all seriousness though swimfast, while I see what you are saying, and while I also see how someone would be really upset if they were labelled as depressed or anxious if they thought there was something wrong with themselves, I don't think these diagnoses are off-base. It is a well known fact that depression and anxiety can exacerbate many conditions, and they can also produce some very distressing symptoms (esp. anxiety) due to how a person's attention is constantly drawn towards the symptoms; however, these types of diagnoses should only be given after other investigations have been done. Also, I just want you to know that I'm not attacking your view--I just wanted to give my two cents. I hope you aren't offended :)
One thing you mentioned, though, is that women are more frequently diagnosed with depression. That's true, but I think that's because women are more expressive and open with their symptoms than men; men may not show their symptoms as readily. That's what I think anyway, it might not be right.
I agree that women are more expressive of their emotions. I do, however, want to point out the fact that there are more symptoms than just being expressively upset when it comes to depression. You are however right about depression being more prevalent in woman...there is approximately a 2:1 ratio between the prevalence of depression in females than in males.

Oh..and ANOTHER BTW, what did your febrile illness end up being?

It never was for sure, but a DO (internist) suspected candidiasis--I am inclined to agree, although a short course of Diflucan did not irradicate the yeast. (I am told it is very stubborn though; therefore, I still suspect it was the problem.) If sx flare again, I will buy Three Lac and assess if there is improvement. (The diagnostic test for candida was too expensive, so doc went on suspicion).

I would like to say, interestingly, that I am feeling better than I have felt in about 3 yrs since I started taking a multivitamin about 3 months ago.

BTW, the Lexapro made me depressed--go figure! I am not a doctor, as I have stated, but I intuitively believe that one can look "depressed" in some ways and still have nothing wrong with their neurotransmitters, which means, to my understanding, that SSRIs and the like would be ineffective or detrimental. Doctors need to find out "Is there or is there not something wrong with the pt's neurotransmitters?" If not, leave antidepressants out of it. I know of tons of people who are given antidepressants when a loved one dies, or when they are going through a divorce or financial troubles, etc. It's natural to be "depressed" under those circumstances! That is natural grieving, NOT clinical depression no matter what anyone says. (It really IS overdiagnosed) I say let the people grieve and work through things sometimes (like they did in the old days) People aren't nearly so weak that they have to have an antidepressant to get through every little normal thing of life, are they?

If not, leave antidepressants out of it. I know of tons of people who are given antidepressants when a loved one dies, or when they are going through a divorce or financial troubles, etc. It's natural to be "depressed" under those circumstances! That is natural grieving, NOT clinical depression no matter what anyone says. (It really IS overdiagnosed) I say let the people grieve and work through things sometimes (like they did in the old days) People aren't nearly so weak that they have to have an antidepressant to get through every little normal thing of life, are they?
You're right, but you're painting a whole bunch of doctors with one brush here. You're right, grieving is a normal process, but you're wrong that that can't lead to clinical depression. Just because someone is grieving doesn't mean that they can't be depressed on top of that. It is normal to go through a period of grieving which can last 6-8 weeks, but if the same person isn't eating or sleeping 5 months later, there is something wrong. Plus, the normal process of grieving usually is considered to have 5 stages:

Denial
anger
bargaining
despair
acceptance.

You don't necessarily have to go through it in that order, but usually those stages are met. Grieving, at first, can have the same symptoms of minor depression like: sleep disturbances, inability to concentrate, low mood etc. etc. Normal grieving, however, does not include suicide attempts, or loss of appetite resulting in serious weight loss, etc. etc. Often people that go through these abnormal symptoms are ones that are predisposed to depression anyway.

That said, most people do NOT need antidepressants when they're grieving, and doctors shouldn't be giving them just to get a "short term" cheer up. All I am saying is that, it is very important to be able to distinguish symptomatology of normal grieving from clinical depression.

Oh yeah, one other thing: the definition of clinical depression (from the DSM-IV) has a statement in it that is as follows: "Symptoms are not better accounted for by a mood disorder due to a general medical condition, a substance-induced mood disorder, or bereavement (normal reaction to the death of a loved one). "

Just to add to what others have said:
Butterflytrans lists the official diagnostic criteria for depression. Note though that, officially, the depressed mood must last most of the day, most every day, for only 2 weeks, to classify as a psychiatric symptom. And it's also important to note that one can fit into the diagnostic criteria for depression without having the symptom of depressed mood, as long as enough of the other symptoms are present.

Another thought...medication is not given only because something is wrong with a person's neurotransmitters. Medications are to treat the result, not the cause, of a person's depressive illness. Our brains have different chemical compositions depending on our moods--this is normal. When we have depression for a longer period of time, we can recover more quickly with a medication to help the brain move back to a non-depressed state.

Not being able to cry is a common side effect. Most the people I have treated say it's wierd but it's worth it in exchange for being depression-free. All medications have potential side effects, but not everyone has them. If you look at an over-the-counter painkiller, you will see that sudden death is a potential side effect. BUT, you realize that this only happens in a small fraction of patients, so you take the drug anyway. This is true of psychiatric medications too.