We have been looking at making sense of how the word 'Depression' is used. This is particularly important as rates of depression appear to be rising dramatically around the world (see previous post).
We have looked at how psychiatrists diagnose depression using the DSM and ICD classification systems. One of the unintended consequences of this has been that there has been the confusion of distinguishing general sadness from actual depressive illness.
Depression is used as a synonym for sadness. However, there is also a clinical condition of Major Depressive Disorder (MDD) that can be a lethal debilitating illness.
Those with depression as illness (MDD that is sometimes called melancholia) have a severe lowering of their mood along with prominent physical effects on the body and can at times become psychotic. This is the group that is most at risk of suicide and responds best to medication.
However, studies that look at just the rate of MDD indicate that the prevalence is actually remarkably stable.
So an American study in 1994 gave a prevalence of 6.1% and in another study in 2003 it was recorded as 6.6%. In England it has been shown that the one week prevalence actually decreased from 2.6% in 2000 to 2.3% in 2007. (For references to these papers see the comments section).
But then at the same time there has been a remarkable increase in the diagnosis of depression and the prescription of anti-depressant medication.
A study from 2011 showed that about 11% of the US population aged over 11 now take an antidepressant, including 23% of women in their 30s and 40s. This represents a 400% increase in the last 20 years!
Another study reports that in the United Kingdom antidepressant medication prescriptions have increased by 495% since 1991.
Those are staggering numbers and strongly suggests that large numbers of people are prescribed anti-depressant treatment without evidence of actually suffering from Major Depressive Disorder.
Why such a huge increase in prescribing?
It would appear to be the result of a combination of factors. There has been heavy drug company marketing and an overemphasis by doctors on a biological model of depression rather than psychological, social or cultural factors. But also there is a trend in Western montauk-monster.com/pharmacy society to expect that we have a right to happiness. That means rather than looking for meaning in our suffering (as traditional cultures have emphasised) through learning virtues such as patience, wisdom and faithfulness, we are tempted to rush to a quick solution to get rid of the pain we are feeling.
James Davies is both an anthropologist and psychotherapist. In his book, "The Importance of Suffering: The Value and Meaning of Emotional Discontent" (2012) he writes about how there has been a secular trend to 'decontextualise' suffering and not see it, as older cultures have, as an integral part of a person's life story.
We have become too preoccupied with the here and now.
In his book Davies refers to a BBC interview with the psychiatrist, Robert Spitzer who headed the task force that in 1980 wrote the DSM-III (see previous post). The interview took place in 2007 or 27 years after the DSM-III was published.
In that interview Spitzer admitted that, in hindsight, he believed they had wrongly labelled many normal human experiences of grief, sorrow and anxiety as mental disorder.
Interviewer: "So you have effectively medicalised much ordinary human sadness?"
Spitzer: "I think we have to some extent... How serious a problem it is, is not known.... 20%, 30%.... but that is a considerable amount."
Later on Davies explains how the DSM focussed almost completely on the symptoms of depression:
"They were not interested in understanding the patient's life, or why they were suffering from these symptoms. If the patient was very sad, anxious, or unhappy, then it was simply assumed that he or she was suffering from a disorder that needed to be cured, rather than from a natural and normal reaction to certain life conditions that needed to be changed."
So while the rate of Major Depressive Disorder may be relatively stable, there would appear to be a sizeable portion of people with significant feelings of unhappiness that is easily confused with a diagnosis of depression.
The reason this matters is that this group of people are being prescribed medication that they do not necessarily need to take.
What other questions or comments does the confusion around the word depression raise for you?