Doctors misdiagnose depression 86 per cent of the time
An accurate title for this story would have been: “86% of over-65s in the U.S. who say they recall a doctor or other medical professional saying they had “depression” in the past year don’t remember enough symptoms in the past year to meet the DSM criteria for MDE“.
Instead, WDDTY magazine went with the scaremongering headline: Doctors misdiagnose depression 86 per cent of the time
That’s a wildly inaccurate account of the research. But the magazine went a step further, and converted that claim into direct advice for its readers. Here’s the first paragraph of the WDDTY piece:
Has your doctor diagnosed you as clinically depressed and prescribed an antidepressant? If you’re a senior citizen, you should get a second opinion — because there’s a very good chance you’re not depressed at all.
That’s both an irresponsible, and an inaccurate, piece of journalism. The research is silent on the rates of 12-month, or current, antidepressant usage for this (or indeed any) sub-group of study participants, so WDDTY has absolutely no basis for its claim that if you are over 65 and have been prescribed antidepressants “there’s a very good chance you’re not depressed at all”. WDDTY gives direct advice to an already vulnerable population, on the basis of misreporting somewhat nebulous research.
WDDTY makes some predictably reckless claims about depression, a serious condition which, if neglected, can destroy (both metaphorically and literally) the life of the sufferer and those around him or her. Needless to say, they conflate “feeling a bit low” with clinical depression, because money. The NHS has information on the symptoms of clinical depression here, with a simple test anyone can do. There is advice on what to do and telephone numbers to call if the situation is urgent. Certainly modern medicine does not yet have a perfect answer to the problem of depression, which presents in a number of forms and may well have a number of causes; nevertheless, this imperfect response is infinitely preferable to the completely and dangerously wrong fuckwittery to be found on the WDDTY website.
The great depression deception (WDDTY, Vol 23.3, June 2012)
Chronic depression has been described as the disease of modern times. It afflicts 121 million people worldwide (1), which equates to around one in 10 adults, while one out of every 13 Europeans is currently (2) taking an SSRI (selective serotonin reuptake inhibitor) antidepressant such as Prozac to counter it.
Tragically, they are all being poorly served by medicine, which is working with an unproven, and flawed, theory of the causes of depression, and with drugs that are doing more harm than good (3).
Instead, a new theory is developing that suggests that depression is the byproduct of the body’s natural inflammatory response to infection (4). If true, an anti-inflammatory would be a better drug therapy than an SSRI (5), and this is supported by the evidence (6), which has found that the SSRI drugs are ineffective in around two-thirds of depressed people (7) (Am J Geriatr Psychiatry, 2011; 19: 839–50).(8)
Wrong. The WHO says over 350 million and simple arithmetic says neither that nor WDDTY‘s figure equates to 10% of 7 billion.
Untrue. The report WDDTY is presumably referring to says, according to Science Daily: “One in thirteen of adult European citizens — and 10% of middle-aged Europeans — took an antidepressant in the previous twelve months“.
A blatant lie. The increase in antidepressant prescription over recent years correlates with a decrease in the suicide rate. While a direct link has not, as far as I know, been shown, it is certainly not evidence of the drugs “doing more harm than good”.
Again, this is misleading. It suggests a single cause for depression. The study I found (dated 3 Sept, 2012, and published in Archives of General Psychiatry) looked at patients with moderately hard-to-treat depression who also suffered from chronic inflammatory diseases, because there is a known correlation between hard-to-treat depression and chronic inflammation.
Again, this erroneously assumes a single cause for depression, and on the basis of a single study to boot. It’s like saying all cancers can be treated by the same drug, or that if we find a treatment for cystic fibrosis it will also work for other genetic disorders, such as dwarfism and Down’s.
Which, you will note, is not forthcoming. Unsupported assertion.
I can find no other instance of this assertion, which I can only conclude has been internally (i.e. rectally) sourced by the anonymous author. Or again, it may be based on a single study on a specific population, and WDDTY has once more massaged the language to make it apply to the general case.
This is the best part of all. I looked up the article at Am J Geriatr Psychiatry, 2011; 19: 839–50. It is not the study the author is referring to. Or, if it is, he/she has been spectacularly dishonest in presenting it. The reference is, in full: The American Journal of Geriatric PsychiatryVolume 19, Issue 10 , Pages 839-850, October 2011 “Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial”
Geriatric depression. In people who have doubtless suffered chronic inflammation for a long time, on top of all the other problems of ageing, and who are taking an anti-depressant. All the abstract confirms is what we suspected all along: a little gentle exercise and socialising does you good, especially as you get older, frailer, and more likely to find yourself isolated.
There’s more to that WDDTY article, much more: all of it similarly debatable, disingenuous or downright dishonest. It all boils down to the usual “self-diagnosis and supplements” mantra you expect from the anti-health extremists. Here’s a second example from another piece, this time online:
Coffee helps ward of depression and suicidal thoughts (30 July 2013)
Caffeine in coffee acts as a mild antidepressant that could even be enough to stop someone committing suicide.
Drinking two or more cups of coffee day reduces the risk of suicide by around 45 per cent, say researchers at the Harvard School of Public Health. They think that caffeine boosts mood hormones in the brain, and stops us feeling depressed. But the benefits seem to stop at around three cups, or 400 mg of caffeine a day, they say.
The published research is here. Notice the title: “Coffee, caffeine, and risk of completed suicide” – completed suicide is not the same thing as suicidal thoughts, or even suicide attempts. It’s a pretty crude measure, really. Notice that WDDTY uses affirmative verbs – “helps”, “acts” – while the researchers themselves carefully employ the conditional – “may”, “appears” and so on. And a “lowered risk of depression” is not the same thing as “stops depression”, otherwise no coffee drinkers anywhere would ever be depressed.
There are other examples of WDDTY’s reckless, misleading and irresponsible reporting on depression, mostly involving the old warhorse of nutrition. Depression is due to bad diet, to lack of various B-vitamins, to hypothyroidism… Well, the last one isn’t entirely false: untreated hypothyroidism can result in depression, but the assertion that “diagnosing hypothyroidism isn’t easy” is a downright lie. It’s very easy; all you need is a blood test. The test is a bit of a pain, admittedly, but only for the patient who’s forgotten to bring music or a podcast to listen to. The biology side of it is pretty simple.
My third and final example of WDDTY’s deadly fuckwittery on the subject is this headline from their webshite. Just the headline, as it’s quite evil enough:
Alternatives to drugs for depression
I find ripping the balls out of WDDTY’s vicious, mercenary falsehoods a briefly stimulating alternative to getting roaring drunk and playing Pink Floyd’s The Wall at neighbour-baiting volume, but it hasn’t cured my depression. Nor will taking extra doses of vitamins that I already get a full daily dose of in my normal diet. Drinking more coffee not only doesn’t cheer me up, it proactively treats any incipient constipation for the next 48 hours, so stuff that. No, all things considered, I’ll keep taking the pills, thank you very much, and make sure I always have someone to get in touch with when things get on top of me.