In this talk of the nation on NPR, there is a discussion between Gary Greenberg, author of “Manufacturing Depression: The Secret History of a Modern Disease” and Peter Kramer, MD, author of “Against Depression” about the increase in diagnosis of depression. Mr. Greenberg believes the disease is overdiagnosed. He says the move from unhappiness to depression was a long and gradual process. He said it all started in the 1960’s when Merck created an antidepressant drug called elavil and needed to sell it. Merck’s marketing campaign said in order to sell the drug you must associate it with a disease. At this time, Frank Ayd wrote a book for doctors called, “Recognizing the depressed patient” to provide doctors with a script to look for patients who fit into that diagnosis of depression.
Mr. Greenberg also states that Merck was not only advertising the drug but they were also advertising the idea of depression, they were advertising the “disease”. He also points out that doctors still don’t know much about the biochemistry of depression but that one wouldn’t know that when they go to see their doctor. In the discussion they also mention the Hamilton Rating Scale for Depression (HRSD) which is a questionnaire that rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight loss and the fact that this scale is the most commonly used for rating depression and it doesn’t always give a depressed person the correct diagnosis and/or treatment.
Peter Kramer states that “it is hard to measure depression with the Hamilton scale and it cannot assign the right medication”. Both Kramer and Greenberg agree that those depressed don’t always get the correct treatment. Mr. Greenberg says, antidepressants don’t do much better than a placebo if one isn’t majorly depressed. He also believes that there are social issues of depression like one losing their job, working too much and not having enough time for family, etc. but says that the country doesn’t care much about that, they would rather treat it with medication.
I thought this discussion was very interesting because it shows what Conrad and Schneider wrote about in the article “From Badness to Sickness” about the power of the medical profession and how drug companies with a profit motive can create diseases such as depression to make money and get away with it. In the article by Conrad and Schneider, they state, “The medical profession dominates the organization of health and has a virtual monopoly over anything that is defined as an illness a “medical” treatment. All the medical profession has to do is make a claim and turn something like unhappiness into depression, so that they can medically treat it with a pill.
I agree with this article because medicine and medical disorders is such a lucrative business. You can see it every single day when you watch TV. There is always some commercial about some new drug that can help you manage your depression or ADHD. Sometimes when you watch these commercials you begin to think that you actually have these symptoms. It is funny to watch because they name the most common issues that any person watching the commercial can relate to so anybody would then think they have this disease or whatever it maybe. Then you rush to your doctor and tell him you need these pills because your diagnosed with clinical depression or so you think you are. Just because somebody on TV said, “Do you wake up at night and go to the bathroom or Do you sometimes have random thoughts of suicide then you must be depressed. Come on, they can’t be serious but people these days believe anything, so they immediately run to get those pills.
TV is a bunch of propaganda…well some of it, I barely watch TV and if I do, I only watch the science channel or national geographic. I feel like those are the only channels that you can actually learn something. Everything else to me is just a waste of time, could be doing something much more productive than watching TV.
Also watching that small movie in class about the kids that are diagnosed with ADHA at such a young age just mind bottles me. I would never give my three year old kid pills. He or she is three, that is what kids do, they act crazy because they are interested in exploring life and everything around them. Let them be, because as you can see taking pills from a young age ruined one kid’s life.
An interesting post Laura! I was just discussing this with my friend the other day. She was trying to argue that there is not such thing as an over diagnosis of depression, because in theory any diagnosis has to be scientifically grounded and founded. Thus, if a diagnosis is made that points towards depression, then the diagnosis is correct.
I argued against this by saying that its possible that the diagnosis could be incorrect. But my friend brought up a good point when she said that science and medicine specifically are fields that are very self corrective; what “experts” believe to be true today is commonly scrutinized and scientific facts can change very regularly. Thus, if a few diagnosis are off today, they will be correct and treated tomorrow. But, in so far as these diagnosis were made for depression, they were correct and accurate in that moment that the diagnosis was made! So, my friend argued that there is no such thing as an over diagnosis. Instead, it was the best diagnosis that could be made at the time.
I still didn’t agree. I think that there are also some strong psychological and social issues that influence the incentives that doctors (and patients) have to take anti depressants. There is a fundamental flaw in the pharmaceutical industry here: they are supposed to be a non bias, purely scientific and empirically based practice. If doctors tell me I need a pill, I’m assuming their doing so with my health and long term well being in mind. However, with the rise of heavy pharmaceutical advertising, a lot of sub conscious fears and behaviors are triggered which lead both doctors and patients to buy a certain pill for non-scientific reasons. This is the problem: advertising obfuscates the pure science of medicine and makes it subjective and inaccurate. This is why over-diagnosis exists!
I think this can be corrected with a more scrutinizing approach to medicine from patients, doctors and the general public. Doctors should be more aware of what pills are actually best for their patients healths, pharmaceutical companies have to stop advertising completely and they have to stop incentivizing doctors to prescribe their medication inappropriately. We need to question any scientifically grounded diagnosis to make sure its leading us to the best possible solution.
-Nikhil