"I'm not sick, I'm just sad"; Study shows 25% of depressed patients are misdiagnosed

Sick or just sad?

An estimated one in six Americans suffer depression at some point in their lives however that number should be 25 percent lower according to a new study. This change is more than a statistical debate; if you are part of that 25%, the treatment you get could be substantially different.

Up to a quarter of people in whom psychiatrists would currently diagnose depression might just be reacting normally to stressful events such as a loss of a loved one, divorce, losing a job, etc.. For these people who are experiencing painful -- but normal -- responses to life's stresses drug treatment may often be inappropriate. Instead, supportive therapy might be a better course of action and keep someone who has experienced a loss (of marriage, job, etc.) from developing a full-blown depression.

According to the Washington Post who reported on the new study:

Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.

The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.

The researchers found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression. Not looking at the context could led to characterize patients as having biological disorders leading then to anti-depression medications.

Drawing the line between normal and abnormal suffering has long been controversial in psychiatry because it is so subjective. People who have no disorders can experience the same symptoms as those who do have a disorder. The difference is in the intensity and length of their reactions. Doctors have the difficult job of balancing misdiagnosing someone with a disorder against not giving treatment to someone who needs it.

Proving how difficult (that is subjective) the criteria can be is the case of the death of loved one. A diagnostic manual used for determining whether or not an unhappy patient is clinically depressed nor not says that "doctors need not diagnose depression if symptoms follow the death of a loved one." But what if the loved one is a pet dog, and now the former owner is experiencing acute grief at their loss? Are their feelings clinical depression or normal sadness? Drugs or support therapy?

Why the tendency to "pathologize" sadness?

Three groups can be seen as contributing to the phenomenon:

Pharmaceutical companies
Psychiatric profession
Patient advocacy groups

The U.S. market for antidepressant drugs is $12 billion-a-year and has every incentive to continue this trend. Patient groups are also incentivized to promote the tend since the more common mental illness is the less stigma that is attached to it.

Allan Horwitz, a researcher at Rutgers University who studies the sociology of mental disorders, believes that companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease makes it easier to do studies, and psychiatry has come to think of itself as "the arbiter of normality." He even collaborated with Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry on a book called "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder." [link below]

Positive psychology's relevance

According to Horwitz:

"The way in which people interpret their emotions is changing. People are starting to think that any sort of negative emotion is unnatural, that they can take medication and feel better. What that can also do is make it less likely for people to make real changes in their lives that might be better than medications."

In other words while medications might be an effective band-aid their usage might reduce the chances for individuals to make the changes that lead to long-term improvements in their lives.

New study does not mean people shouldn't seek help

The researchers noted that "people who are in pain after a divorce or other stressful event should not conclude that they simply ought to 'buck up.' They should seek the counsel of clinicians who would take the time to explore what caused the symptoms and whether they need treatment."

Amazon link: The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder