I was asked on Twitter:
When did depression stop being an emotion and start being a mental illness? #seriousQuestion
This is a really important question, and topical too, given the ever-increasing prescriptions for antidepressants written and filled throughout much of the world, and recent studies casting doubt on the efficacy of those medications (there are problems with those studies, and the breadth of their conclusions – even though there might be a kernel of truth to them).
So what is depression?
Depends who you talk to, and the context of the conversation. We all feel sad at various times, and when we so, might even say “I’m so depressed”. While sadness is an unpleasant state, it’s none of my business as a psychiatrist unless it is accompanied by the trappings of psychiatric illness…. So what does that mean then? The easy, pat, concrete and simplistic answer would be to refer you to the criteria for Major Depressive Disorder as set out in the DSM IV- TR, or the ICD-10. The Diagnostic and Statistical Manual of the American Psychiatric Assoiation, and the International Classification of Diseases (UK/Europe) contain lists of criteria for specific diagnoses, with the goal of increasing the number of things US psychiatrists can charge HMOs and insurance companies for standardising diagnostic practice, and thereby enhancing treatment through better comparisons and research.That wouldn’t be a particularly helpful answer though – and it would be one you could have got yourself, without reading my ramblings.
When is depression an illness?
Shouldn’t we all just pull our socks up and get on with it? Are we just big sooks? Are psychiatrists simply making a mint out of pathologising normal human experience? Well … Not really – overall at least. Read more [+]