Is depression a hyped disease? Perhaps it is not.
Yes, says Robert Sapolsky, a professor of neurology at Stanford, former MacArthur Fellow and expert on human behavior: “I think [depression] is absolutely a disease. I believe that it is as much of a biological disorder as is, say, diabetes.”
Depression is a serious problem. That sense of hopelessness, exhaustion and alienation is dreadful. But let’s not exaggerate its extent or severity—or the relevance of medical intervention. Here are six key reasons:
- Depression is already the leading cause of disability worldwide. However, there is no epidemic.
- The diagnosis of depression is a rag-bag of different conditions. It is not really a disease. Depression is better understood as a symptom, like fever or pain. Most people given the diagnosis are not mentally ill, they are responding to life’s stresses and difficulties. That’s why it’s more common during periods of economic turbulence or emergencies.
- The rag-bag has got bigger with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now includes grief in the diagnostic framework. This will spuriously expand the apparent prevalence of depression. Turning grief and other responses to loss into a mental disorder is a medical intrusion into private emotions. It substitutes a superficial medical ritual for deep and time-honored cultural ones and stigmatizes the experience.
- It is wrong to assume that mild cases tend to become severe if left untreated, and that early intervention is needed to nip this problem in the bud. This assumption may sometimes work well for cancers but does not apply to depression. Most people who get depressed do so mildly—and mild depression usually resolves spontaneously.
- In the West, the problem is not under-diagnosis of depression. The problem is over-diagnosis. General practitioners (GPs) are 50% more likely to diagnose depression when it is not present than to identify a case correctly or miss a case when it is present. In a recent US study, only 38% of adults with clinician-identified depression met formal diagnostic criteria.
- They also over-medicate. In the US, 11% of people aged 12 and above take antidepressant drugs, including 23% of women in their 40s and 50s. Antidepressant prescribing increased by 10% each year in England between 1998 and 2010; 53m prescriptions were issued in 2013. However, antidepressant drugs do not help most people. Only in severe cases are they demonstrably more effective than placebos. The main beneficiary of this boom in antidepressant prescribing is not the patient, but the pharmaceutical industry.
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