Depression- the latest gold rush for the medical pharmaceutical complex
This L.A. Times article of January 26, "Federal panel recommends general physicians screen all adults for depression" caught my attention with this quote:
The new recommendations, published Tuesday in the Journal of the American Medical Assn., ensure that virtually all adults consulting with a physician will at some point be asked a battery of questions aimed at discerning the signs of depression. Among those are prolonged sadness or irritability, feelings of guilt and worthlessness, disturbances of sleep or appetite, and loss of energy and interest in activities once a source of enjoyment.
Then it gets into the hard sell:
"What this recommendation is saying is that, as a country, we don't have an excuse" for failing to diagnose and treat depression, said UCLA psychiatrist Dr. Nelson Freimer, director of a university-wide initiative that aims to improve depression care and uncover the biological bases for the disorder.
"This is one of the nation's leading killers and causes of disability, and it has enormous effects throughout our society. It's just too important to be optional," Freimer said.
Increasingly, physicians in family medicine and general care are the first to suspect depression in their patients. Those doctors' growing role in prescribing antidepressant medication has driven the growth of those drugs, which, despite doubts about their effectiveness, are the third most commonly prescribed class of medication in the United States. In 2010, more than 253.6 million prescriptions were filled for antidepressants, according to a report by IMS Health. Roughly half of patients who seek treatment for depression, however, do not report their symptoms having resolved completely, said Freimer.I went to the website of the U.S..Preventative Services Task Force to look up the research that is used as justification for this recommendation: It took some searching, and then found the PDF for "Screening for Depression in Adults. The copy function was disabled so the following is hand copied from pp 56 "Conclusion"
"Although direct evidence of the isolated health benefit of depression screening in primary care is weak, the totality of evidence supports the benefits of screening in pregnant and postpartum and general adult populations, particularly in the presence of additional treatment supports such as treatment protocols, care management and availability of specially trained depression care providers."The paragraph concludes with: "Evidence is least supportive of screening in older adults where direct evidence is most limited and did not demonstrate a beneficial effect. Generating from evidence in all adults to older adults may be reasonable."
A clear single click demonstration of this thesis is found in this article, Grief Over New Depression Diagnosis, from the New York Times, in the contrast between what is being reported and the comments (under title) and then selected by "reader picks." The article describes the revision in the DSM psychiatric manual of disease identification eliminating the normal grieving exclusion to make it a judgement call -- not by the patient but the doctor. It is the professional at his/her discretion to decide how much sadness after the loss of a spouse is normal-- or a sign of the medical condition of depression.
There are none among those who commented on the N.Y. Times article (including this writer) who would deny the potential efficacy of psychiatry, --- none who would prefer, for instance, prayer or confession of sins. The Times readership, and all of the top twenty recommended comments were of the excesses that this change could produce, most specifically in the focus on medication rather than talk therapy, a treatment not exclusive to those with medical degrees.
There is a more radical argument, one that I endorse, that is a broader challenge to placing any condition except the most obvious expressions of psychosis under the medical rubric. This was expressed by the now forgotten Thomas Szasz in the 1960s, articulated well by this essay from the New Atlantis, "The Neuroscience of Despair"
This is cogent article on this general subject from the N.Y. Times: Bursting the Neuro-Utopian Bubble
By Benjamin Y. Fong
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