Medical Depression linked to depressing events

[Ivan Seeking]

Study shows some diagnosed with depression may be reacting naturally to stress

WASHINGTON -- Up to 25 percent of people whom psychiatrists would currently diagnose as depressed may only be reacting normally to stressful events like divorces or losing a job, according to a new analysis that re-examined how the standard diagnostic criteria are used.

The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists in identifying people who might be depressed, and the $12 billion a year U.S. market for antidepressant drugs. [continued]

http://www.dailymail.com/story/Life/2007040371/Study-shows-some-diagnosed-with-depression-may-be-reacting-naturally-to-stress/

I am trying to think of something to say that won't require that I ban myself. One would think that someone might have looked at this long ago...?

 

[Ivan Seeking]

For some reason I posted this in biology when it should be here. Redirect expires in one day.

 

[denverdoc]

Ivan_S,

well its nothing new under the sun. When i was in med school the thesis was that depression came in two varieties, endogenous (ie bad brain chemistry), and situational--grief rxns etc. The former got meds and talk therapy, the latter just talk therapy. Then the prozac revolution..all of a sudden antidepressants without risk: whereas before a weeks worth of doses taken at once could land you in the morgue, things were revolutionized, take a whole bottle, hell make it two, whacked out for a few days but alive and kicking.

During this time and later because of recognition of profound impact of depression on health, welfare, productivity--depression costs more than breast cancer among woman--there was a huge movement to treat, and because of stigma, and access, depression became a primary doc mandate. Simple questionaires developed, and on the basis of two minutes and a checklist, or even a request by patient, scripts got written.

I think for the most part conscientious psychiatrists make this distinction on a daily basis. I wouldn't prescibe AD's for bereavement until at least 3 months out.

On the other hand evidence is accumulating implicating the role of stress hormones in depression, and it appears that there is subpop who are very vulnerable to stress induced depression and deserve/benefit from Rx.

All the while there is a huge industry and pharms spend a lot of money sending reps into GP's/PCP offices and paying me $$ to educate them over fancy dinners. There is no doubt that we are both overprescribing yet missing the real target.

 

[Type 7]

I think there may be one other factor in the increase of prescriptions written, and that is fear that the patient might commit suicide before safely passing through the nadir of the grief cycle.

Sometimes it the parents fear for their teenager (although now it's thought that meds might increase the risk in some cases). Sometimes it's the psychiatrist's judgement that the patient needs a temporary crutch. And sometimes it's the fear of lawsuits. It's not hard to imagine the courtroom scenario

Lawyer: Right here in the patient's file it says 'depression.' Was that your diagnosis?
Pychiatrist: Well, yes.
L: And you believe that diagnosis was correct?
P: Yes, based on my evaluation, I do.
L: [holds up photo of the deceased] Then why didn't you prescribe an antidepressant?!
P: Umm...

Judge: BAM!
Jury: One million dollars.

Please understand that I mean NO disrespect to any medical practitioner. Being malpractice savvy is essential for survival. It's just a fact of life.

 

[denverdoc]

I think there may be one other factor in the increase of prescriptions written, and that is fear that the patient might commit suicide before safely passing through the nadir of the grief cycle.

Sometimes it the parents fear for their teenager (although now it's thought that meds might increase the risk in some cases). Sometimes it's the psychiatrist's judgement that the patient needs a temporary crutch. And sometimes it's the fear of lawsuits. It's not hard to imagine the courtroom scenario

Lawyer: Right here in the patient's file it says 'depression.' Was that your diagnosis?
Pychiatrist: Well, yes.
L: And you believe that diagnosis was correct?
P: Yes, based on my evaluation, I do.
L: [holds up photo of the deceased] Then why didn't you prescribe an antidepressant?!
P: Umm...

Judge: BAM!
Jury: One million dollars.

Please understand that I mean NO disrespect to any medical practitioner. Being malpractice savvy is essential for survival. It's just a fact of life.

Absolutely, this is a factor, esp when the risk of prescribing appears to be small, while the risk of not prescribing seems so great. The problem is sinking into the lowest common denominator of what a skilled and prudent colleague would do under the same circumstances--this is a strong pull toward the generally risk averse and really expensive/dumb medicine that is so prevalent in the US IMO.

 

[Solidly-here]

Ivan_S posits: "some diagnosed with depression may be reacting naturally to stress."

To this I would say: This means that given a certain amount of stress, a person is supposed to get depressed.
But, since most people (with equal stress) DON'T get depressed, then it's not natural to be depressed ... it's just a state of emotional dysfunction that some people experience.

A similar statement of cause-and-effect could be: Given a certain amount of salt intake, a person is supposed to get high blood pressure.
The reality is: EVEN among people with high blood pressure, only a third of them need to restrict their salt intake. The rest of them can have as much salt as they can hold, and rely on their liver to flush-out all of the excess salt.

I think that depression premise is silly.
Better to say: Some people react better to stress than other people.

 

[Evo]

Stress can certainly be a factor in depression. Also, please use the quote button, or use the [quote ][/quote ] tags when you quote someone.

 

[denverdoc]

Ivan_S posits: "some diagnosed with depression may be reacting naturally to stress."

To this I would say: This means that given a certain amount of stress, a person is supposed to get depressed.
But, since most people (with equal stress) DON'T get depressed, then it's not natural to be depressed ... it's just a state of emotional dysfunction that some people experience.

A similar statement of cause-and-effect could be: Given a certain amount of salt intake, a person is supposed to get high blood pressure.
The reality is: EVEN among people with high blood pressure, only a third of them need to restrict their salt intake. The rest of them can have as much salt as they can hold, and rely on their liver to flush-out all of the excess salt.

I think that depression premise is silly.
Better to say: Some people react better to stress than other people.

Actually, in many people who experience stress induced depression, the physical structure of the seritonin transporter is different.
http://www.futurepundit.com/archives/001611.html
http://www.bio.davidson.edu/Courses/genomics/2003/mccord/5-HTT.html