A friend of mine went to the doctor last week, complaining of continuing pain following a back operation. She came out with a script for Effexor. She doesn’t have a history of depression, nor symptoms that would trouble a depression inventory. But she wept during the appointment.
[Added later: The prescription was for treating depression, not part of her pain management strategy.]
In June last year the well known Lancet journal published a review of studies on GPs diagnosing depression. The review included 42 past studies and over 50,000 patients. It found that GPs correctly diagnosed depression in less than half of all cases, and incorrectly diagnosed it in 19% of the healthy patients.
What’s going wrong?
I have personal experience too. I was diagnosed with depression by my GP in 2001. He recommended treatment with an anti-depressant. “They’re all pretty much the same” he said, “and I’ve got some samples. I haven’t tried this one in a while – let’s give it a go!” For the briefest of moments I admired his Lilly rep.
2 years later I had my treatment reviewed by a psychiatrist, who picked bipolar very quickly. Not only was my treatment wrong, but for 2 years I was taking drugs at a sub-therapeutic level. As many of you know from hard experience, an extra 2 years of mental illness is a big loss. I still grieve those years. How I wish my doctor had referred me.
And my relative? Her specialist sorted it out quick smart. Her pain and cholesterol drugs were interacting.
There are so many problems in our health systems and I don’t pretend to know any answers. But GPs are on the front-line of psychiatric care, and it’s not about to change. Less than 50% is poor when people have lives to live. Somehow the bar has to be raised.