Mr. Ramos

Writing for the Sciences

May 7, 2015

Just What the Doctor Ordered:
The Over-Diagnosis of Depression

Depression is one of the most common mental illnesses in the world. With
15 million adults suffering from the illness every year in the United States alone, this disease is far from delusive. More so, the number of adults suffering from depression is estimated to be much greater considering that the illness remains undiagnosed for a large chunk of the affected population. Well, what exactly is depression? Falsely believed to be temporary sadness, depression is in fact a mental state that debilitates behavior, physical health, and individual thoughts. Therefore, patients who do suffer from depression should be receiving immediate and proper diagnosis to promote quick and effective treatment. Interestingly, in the last 30 years, the number of people diagnosed with depression has quadrupled. Does this mean that world population is developing a global mental illness? No, it means that depression is being misdiagnosed as well as over-diagnosed. Depression over-diagnosis is an ongoing predicament in many countries that -like almost all other over-diagnoses-can lead to serious consequences. However, there are some who oppose that over-diagnosis is actually happening. Furthermore, the same opposition believes that over-diagnosis wouldn’t be a problem considering that depression treatment is not economically exhausting and that patient mentality can only improve from depression treatment. Meanwhile, the truth is that over diagnosing depression is a reality that is costing the United States unnecessary billions, and it is a danger to patients due to the malignant side effects of depression medication and treatments.
Is Over-Diagnosis a thing?
To begin understanding the misdiagnoses and over-diagnosis of depression, one must analyze the criteria by which professionals assess patients. Prior to 1980, depression was either melancholic (classified by sad mood) or neurotic (classified by stress)[1]. This classification was described in the American Psychiatric Association Diagnostic and Statistical Manual (DSM) second revision. After 1980 however, the American Psychiatric Association revised the DSM for the third time. This third revision divided depression in major and minor disorders Major depression, of course, refers to a longer term and more serious mental illness. However, it wasn’t this new division of the mental illness that led to over-diagnosis, but rather the low criteria required for patients to actually be diagnosed [1], [2]. According to DSM III (third revision), patients had to display a “sad” or “blue mood” for only two weeks as well as increased fatigue and a change in sleep patterns [1]. It wasn’t until 1994 that a stricter criterion was promoted through DSM IV (fourth revision) due to further psychiatric studies and advances [1], [2], [3].
With this brief history of DSM criteria presented, we can now assess the prevalence of depression diagnoses through DSM. DSM III, with its surprisingly low requirements, caused a jump in number of people diagnosed with depression [1], [2]. Furthermore, when diagnosed with either major or minor depression under these criteria, patients receive medical coverage for all kinds of prescription [2], [4]. Therefore, patients who may have been experiencing temporary sadness could be diagnosed with depression and begin taking extensive medication that they don’t even need. This however, was prior to the 1994 DSM revision that we continue to use today.
DSM IV, unlike DSM III of the past, requires that patients express depressed moods, fatigue, insomnia, weight changes, etc. nearly everyday for 12 months, unlike the two weeks required in DSM III [3]. This advancement in criteria was directly due to advancement in our own psychiatric knowledge about depression illness [1]. With the stricter DSM IV, we can assume that depression diagnoses will be limited to those only affected by the serious mental illness and not to anyone who isn’t, right? Wrong. In a study conducted by John Hopkins University in 2013, it was found that 38.4 % of 5000 adults diagnosed with depression actually met the 12-month criteria described in DSM IV. That means that about 3000 people in this study believed they were depressed due to their clinicians’ misdiagnoses, and were taking heavy prescription drugs. In patients who were 65 years or older, 6 out 7 people actually met the 12-month criteria [5].
The reason behind such staggering numbers of over-diagnosed patients is that mental health professionals in the U.S. tend not to perform the formal interview prescribed by DSM