Are family practitioners qualified to dx depression?
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?
Re: Are family practitioners qualified to dx depression?
Quote:
Originally Posted by philipsmom
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?
Last edited by butterflytrans; 07-02-2004 at 12:47 AM.
Re: Are family practitioners qualified to dx depression?
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.
Re: Are family practitioners qualified to dx depression?
Quote:
Originally Posted by butterflytrans
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?
Re: Are family practitioners qualified to dx depression?
Quote:
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). "
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