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.
Your thoughts?
Diana Lee 16 Mar 2010 @ 10:13 am
It’s not at all uncommon to use antidepressants off label as a treatment for pain. I don’t think there is any reason to think the doctor was asserting the pain was in the person’s head or diagnosing depression.
However, I don’t think GPs should be diagnosing depression and leave it at that. They should ideally refer patients to therapy and psychiatrists for evaluation and further treatment. Treatment takes a full rounded approach, even assuming a diagnosis of depression is correct.
james 16 Mar 2010 @ 1:10 pm
I think that part of the problem is that doctors are constrained by a lack of time. In the study I mentioned there was much better success with diagnosis where longer follow-up appointments were made, which of course makes sense.
The friend that I wrote about was prescribed anti-depressants for depression subsequent to pain, not as a treatment for the pain itself.
Kat MacKinnon 17 Mar 2010 @ 10:38 am
Long gone the days when a person used to have the same doctor almost all his/her life! How easy it is to explain to a new face all you symptoms in under, say, 10 minutes?
Can this doctor ‘justify’ a couple of follow-up appointments before prescribing the medication?
I don’t think so. Unfortunately, NHS is thinking short-term most of the time.
Kat (www.LiftMyDepression.com)
james 17 Mar 2010 @ 12:09 pm
Obviously a lot of doctors are competent in diagnosing depression, and the study bears that out. My wife’s doctor says that one in four of his appointments relates to depression. If this is representative then they certainly don’t lack for practical experience.
But general practitioners are generalists and not specialists. If they haven’t developed skills in mental health then they should refer to someone who has. Many do this of course, but for a myriad of reasons it seems that many others don’t.
Curiosity 18 Mar 2010 @ 7:40 am
I know that the first time I cried out of frustration in a doctor’s office, they said. “Oh. You’re depressed.” and then sent me away with no further information, and no additional diagnostic questions. Grrr.
Lucy 24 Oct 2011 @ 3:17 pm
I know exactly what you mean, I am working as a counsellor in a small town and have a degree in psychology honours. I understand the importance of medication in mental health but also think that it needs to be considered very carefully before deciding this is the course of action and also needs to be carefully monitored once on them. I find that people have better success on one than others and they are certainly ‘not all the same.’ I think the over diagnosis of depression, based on asking a couple of questions and not even conducting a k10 is counter productive. GP’s are more than often the first port of call for those suffering from mental health issues so I think its essential that they are well trained in this area.