One in Four Diagnosed with Depression Are Misdiagnosed

One in four people who are diagnosed as being depressed are simply reacting normally to stressful events such as divorce or job loss, according to new research.

The study appears today in the Archives of General Psychiatry, and is based on survey data from more than 8,000 Americans. The study did not analyze the number of people who had been misdiagnosed.

They found that people who had been through many stressful events frequently had prolonged periods of depression symptoms. Only a small percentage, however, had severe symptoms worthy of being classified as clinical depression, according to the researchers.

The study indicates that the standard definition of depression should be redrawn to exclude the reaction to normally stressful events, so that unnecessary stigma and misdiagnoses can be avoided.

Psychiatrists and other doctors who take medical histories do so to rule out such events, along with the effects of physical illness, before they diagnose someone with depression.

The American Psychiatric Association's diagnostic manual, however, does not specifically exclude people who experience deep but normal feelings of sadness, unless they result from the death of a loved one. A number of school districts and health clinics use simple depression checklists that take no context at all into account, according to the study.

"Larger and larger numbers of people are reporting symptoms on these checklists, and there's no way to know whether we're finding normal sadness responses or real depression," said Jerome C. Wakefield, the study's lead other, a professor of social work at New York University.

Wakefield's co-authors include Allan V. Horowitz of Rutgers University, Mark F. Schmitz of Temple University, and Dr. Michael B First, a Columbia psychiatrist who actually edited the aforementioned current version of the psychiatric association's diagnostic manual.

The study shows that previous estimates of the number of Americans who have had depression at least once during their lifetime, more than 30 million, are about 25 percent too high.

"I think the concern this study raises is real, and that we do need to be very careful not to overdiagnose a normal, homeostatic response to loss and call it a disorder," said Dr. Darrel Regier, director of research for the American Psychiatric Association.

The study analyzed responses from 8,098 adults to survey questions between 1990 and 1992.

Sources:
http://www.sun-sentinel.com/features/health/sfl-adepression03apr03,0,2618377.story?coll=sfla-news-health
http://www.boston.com/news/nation/articles/2007/04/03/many_diagnoses_of_depression_may_be_misguided_study_says/