Making fewer depression diagnoses: beneficial for patients?

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Abstract:

Currently, general practitioners actively search for depressive disorders in their patients. When they diagnose 'depressive disorder', they tell their patients that they have a disease and can be treated accordingly. This is probably an important reason for the huge prescription rates of antidepressants. In doing so, general practitioners implement specialised, psychiatric diagnostic methods in a setting characterised by patients with symptoms that superficially may resemble those of depressive disorder but in reality mainly arise from normal problems in everyday life due to losses of valued relations or failure to achieve desired goals. We argue that it might be beneficial for patients if general practitioners, in a stepped care approach, hold back on specialised methods of psychiatry and instead use a more generalist approach as first step, in which patients' problems are formulated in their own words, and efforts are directed in helping patients regain their self-confidence to solve them. Our arguments for directing attention away from diagnosing depressive disorder are: depressive disorder is a diagnosis by agreement and therefore relative, so there are other ways to look at problems than though psychiatric glasses; depression has unclear boundaries with other mental disorders and with normality; depression is often not an adequate summary of the real problems of the patient; the patient often has a very different conception about what is wrong and often does not agree with the proposed presence of a mental disorder; to diagnose depressive disorder may have more disadvantages than advantages for the patient;. the efficacy of antidepressants is very modest.

Keywords: ANTIDEPRESSANTS; COMMUNICATION; MAJOR DEPRESSION; PATIENTS' VIEW

Document Type: Research Article

Affiliations: 1: Department of Primary and Community Care, Radbound University, Nijmegen, The Netherlands 2: Professor of Primary Medical Care, University of Liverpool, UK

Publication date: September 1, 2008

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