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Depression 'being over-diagnosed'

Too many people may be being diagnosed as clinically depressed when they are simply sad, researchers claim.

Professor Gordon Parker, a psychiatrist at the University of New South Wales in Sydney, Australia, argued in the week's BMJ that depression is being overdiagnosed because the threshold for ‘clinical depression' is too low.

‘Depression will remain a non-specific ‘catch all' diagnosis until common sense prevails,' he said.

He explained it is normal to feel depressed and that his follow-up study of 242 teachers found that 79 per cent met the symptom and duration criteria for major, minor or sub-syndromal depression after 15 years.

He blamed changes to the Diagnostic and Statistical Manual (DSM) categorisation of depression introduced in 1980 for downgrading the diagnosis. This saw the condition split into ‘major' and ‘minor' disorders.

The simplicity and gravitas of ‘major depression' gave it cachet with clinicians, while its descriptive profile set a low threshold, Professor Parker said. Criterion A required a person to be in a ‘dysphoric mood' for two weeks which included feeling'down in the dumps'. Criterion B involved some level of appetite change, sleep disturbance, drop in libido and fatigue. This model was then extended to include what he describes as a seeming subliminal condition ‘sub-syndromal depression'.

But Professor Ian Hickie also argued in the BMJ: ‘If increased diagnosis and treatment has led to demonstrable benefits and is cost effective, then depression is not being over diagnosed.'

He said that this was the case because increased diagnosis and treatment had led to a reduction in suicides and increased productivity in the population. Furthermore the stigma of being ‘depressed' had been reduced.

People who are simply sad are being wrongly diagnosed as depressed, psychiatrist argues People who are simply sad are being wrongly diagnosed as depressed, psychiatrist argues

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