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Doctors Over-Diagnose & Over-Treat Depression

Many of us have friends or family who have been affected by depression. After all, National Institutes of Health statistics show that, depression, also known as Major Depressive Disorder (MDD), is the leading cause of disability for people between 15-44 in the U.S., affecting about 14.8 million adults annually.

Yet despite the progress made towards recognizing, treating, and most importantly, accepting this challenging illness, how effective are our current methods of identifying and healing depression?

Not very, according to a new study published in the journal Psychotherapy and Psychosomatics. Researchers from Johns Hopkins University’s Bloomberg School of Public Health and Department of Psychiatry and Behavioral Sciences found that over-diagnosis and over-treatment of depression is common in the United States.

“Only 38.4% of patients diagnosed with depression had a major depressive episode in the past 12 months yet almost 75% of study participants used anti-depressants.”

For their study, researchers evaluated 5,639 patients who were diagnosed with MDD by a doctor in a non-hospital setting between 2009 and 2010. At in-person interviews over a period of 12 months, patients were re-evaluated for MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), a manual widely relied upon by the medical community to provide the standard criteria for the classification of mental disorders.

Did You Know? EPA/DHA in Fish Oil Can Ease Symptoms of Depression

To meet the official criteria, patients had to have experienced a major depressive episode in the past year, where the major depressive episode is defined as a debilitating, depressed mood, or loss of interest in daily activities for at least two consistent weeks.

Results revealed that only 38.4% of patients who had been diagnosed with MDD experienced a major depressive episode in the past 12 months. This group of patients was found to be more likely to suffer from “probable severe mental illness” and to report thinking about or attempting to commit suicide.

The potential for misdiagnosis was found to be higher among older adults. Of the study participants who were 65 or older, only 14.3% met the criteria for MDD. Patients who felt they were in poor health, who were out of the workforce, who were divorced or separated, or who had higher levels of education were more likely to be correctly diagnosed with MDD.

Of the 61.6% of participants who did not meet the criteria for MDD, 42.7% did qualify as having had depressive symptoms at some point in their life; they either experienced an earlier major depressive episode or minor depression.

Despite these discrepancies, almost 75% of all study participants reported using prescription medications to manage their symptoms. Even when patients who experienced some depressive symptoms were excluded, 69.4% of the participants with unconfirmed diagnoses had used antidepressant medications.

Study author Ramin Mojtabai suggests that the staggering false-positive rates of depression diagnosis may be attributed to "clinicians' uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes," and show the "need for improved targeting of diagnosis and treatment of depression and other mental disorders in these settings."

The Bottom Line

In the past decade, the use of antidepressants has grown so dramatically that today one in four women in their 40s and 50s is taking an antidepressant. The causes for this exponential growth? The study authors cite a number of reasons, including strong marketing by pharmaceutical companies and diagnosis by a general practitioner who may more readily prescribe these medications. It also doesn’t help that many Americans hope to find a cure for what ails them in a pill.

While depression, especially Major Depressive Disorder, is a serious issue, a wide range of treatment options is available beyond just treatment with drugs or visiting a therapist; these options may also be used in conjunction with these treatments to help manage or improve healing.

You may be surprised to know how deeply your lifestyle can affect your health, including your mental health. Changes in diet and activity have been shown to help improve mood. Here are a few tips to keep your physical and mental health in tiptop shape:

  • Set up a routine. It’s tough completing tasks when you’re struggling with depression. Setting up some structure in your life in the form of a daily schedule can help make your days more manageable.

  • Eat healthy foods. Recent studies have linked diet, especially junk food, to increased incidences of mental disorders, especially depression. Eating more healthfully may decrease your chances of becoming depressed. We also tend to overeat when depressed, but reaching for more healthy alternatives may help break part of the cycle that perpetuates depressive symptoms. Also, avoid caffeine and alcohol, which may negatively impact your mood.

  • Consider supplements. New studies have shown that omega-3 fatty acids found in fish oil may improve cognitive function in the brain and help treat depression. Vitamin B deficiency, especially folic acid, B6, and B12, has also been linked to depression, so make sure you are getting enough.

  • Exercise. Multiple studies over the past 3 decades have shown that exercise helps to reduce depressive symptoms. When we exercise, our bodies release endorphins, hormones that make us “feel good.” Regular physical activity can help our brain chemistry, so get moving.

  • Get good sleep. Getting too little rest can worsen depression symptoms. Try to eliminate any distractions in the bedroom, such as TV, computers, or other electronic devices, and try going to bed at a regular time each day.

Being healthy doesn’t just mean keeping your body fit – it means doing everything you can to keep your mind, body, and soul in harmony. After all, treating yourself well is the most important part of any treatment.

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