you wrote "psych world are asking themselves plenty of questions".
I hope they are asking themselves questions, but I seriously doubt it. To pass the test to be an accredited psych professional , all doubt is/has to be erased. If one doubts that they (psych) are helping people, then the God like decisions they make every day might be wrong. Gods can't be wrong!

You find great papers Phillip.

I'm glad somebody is thinking about overdiagnosis (and managing to get the paper published).

I wonder if these days bipolar may get overdiagnosed in a similar way, especially now that it's so popular to be bipolar II or NOS. I had an agitated response to what was truly an awful family situation in my late teens that resulted in my bipolar diagnosis. No one at the HMO factory where I got treatment even bothered to ask about my life situation. 9 years and countless meds later, I'm off meds, reconciled with my family and totally fine. I have to wonder what would have happened if someone had listened in the first place.

This is why my psych is cautiously watching me and my medications[as in not increasing Lamictal too fast].My psych was very in tune to the fact that I had a friend die right at official bp dx time; among other things. When I filled out those [pharma created]depression scale papers, the pdoc said I was totally off of the charts depressed. Taking the charting of my moods, and my environment at home, specifically monitoring my grieving process for a death of a friend, are all factors in not over-medicating my real life events.
Pdoc likes to say "Even though all of this is going on, you are stable."
Depression and bipolar are one thing, and life events are another. A person has to know when to focus the medication where it needs to be, and the rest just works out.
About teens--yeah Lord have mercy if they were medicated over friends coming and going, boyfriend, girlfriend stuff. That's just part of life.

Sometimes I am so dismayed by the drivel that gets published in medical journals. I mean do we need a scholarly journal to tell us something that any reasonable person should be able to figure out. This is not rocket science. The whole field of psychiatry is so out to lunch with their symptom checklists and "disease" obsession. It makes me sick. Admissions that something is amiss both with diagnosis and with treatment are long, long overdue.

I saw this in the Times, hardly a shocker.

Paradoxically, it opens a logical hole in field for "acute reactive depressive disorder" or some such shit.

In fact there's already a pill for that, it's part klonopin, part paroxetine and part laxative : Klonoparoxepsyllium (trade name Trickium).

It really isn't surprising that depression is overdiagnosed. Every time I turn on the television there is some commercial reminding me that it's not normal to feel sad. I think the marketing of depression has been very effective.

Good article you wrote. Like your sources too. I actually heard about this on Action News or something the other night. You would think that the reasons that they are misdiagnosed would be common sense, but I guess nobody thought of them for whatever reason. I mean, of course a person can get sad for a long period of time if something traumatic happens to them, doesn't mean they're clinically depressed.

I just read the original paper - it was fascinating and thanks Philip for picking up on it. It does confirm the common sense notion that sadness resulting from life traumas should not be considered categorically different than the sadness resulting from bereavement.

But it does rely on making a distinction between 'uncomplicated' vs. 'complicated' depressive reactions. Which is fair enough from a scientific point of view, since DSM only considers 'uncomplicated' bereavement to exclude a patient from receiving an diagnosis of Major Depressive Disorder, and it is this 'uncomplicated' exclusionary space that the authors seek to have expanded to include 'uncomplicated' reactions to other losses or stressful events. But in spite of enabling the authors to re-calculate the lifetime prevalence of depression as 11.3% (originally reported as 14.9%), the feeling the paper left me with was of a 'soft' result (necessarily constrained by research protocols) that does not actually pose much of a challenge to the ideology masquerading as science that underpins the conceptualisation and diagnosis of depression.

'Complicated' episodes, whether triggered by bereavement or other forms of loss, were distinguished by the authors from 'uncomplicated' episodes by the existence of at least two of the following: morbid preoccupation with worthlessness, suicidal ideation, marked functional impairment (not being able to work or socialise) or psychomotor retardation, prolonged duration (> 12 weeks) or a suicide attempt. Such 'complications' would enable a diagnosis of depression regardless of any precipitating factors.

I think most of us would agree that someone suffering from at least two of the above might benefit from (and indeed require) some kind of intervention, although those of us who have been damaged and marginalised by the excessive emphasis that mainstream psychiatry places on biogenetic causes would have to seriously question whether psychiatric interventions would be of any use. I doubt that as a result of this paper, mainstream psychiatry will ever stop to consider whether the concepts of 'disease' and 'disorder' are still out of place even in 'complicated' responses to bereavement and other losses, and to begin to think in terms of 'injuries' instead. As the authors point out, false-positive diagnoses can lead to stigmatisation, but even 'true-positive' diagnoses could be reframed in a less stigmatising way.

And in response to Mark above: it should come as no surprise that three out of the four authors of this paper are social workers, not psychiatrists!

Hi Phil,

Interesting post. It is important to note the difference between grief ( death of a loved one) which is normal, and a major depressive episode.

A major depressive episode is defined as two straight weeks of experiencing 5 of the 9 symptoms of depression. That is not normal. Does anyone genuinely know the definition of "normal?" I don't.

Charlie

Is it just me or has NO other media outlet picked up this story?

NYT is doing a good job so I'm working to forgive them for their coverage of the media angle on Hurricane Katrina, i.e. if you're upset about being flooded out of your home and losing all of your possessions you are mentally ill:
http://www.nytimes.com/2006/06/21/us/21depress.html?ex=1308542400&en=c1af78f3e8a426c3&ei=5088&partner=rssnyt&emc=rss

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