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?

A one-legged chicken from the south of Wales has recently recovered from depression.

Lily is not your everyday chicken. She sleeps on a cushion in the kitchen of a two bedroom terraced house and she eats spaghetti bolognese. Her owner Vicky Mills says she struts about as if she rules the roost – “she really thinks she’s top of the pecking order”.

Lily damaged her leg in an accident with barbed wire. In an attempt to save the leg Vicky spent £2,000 on 7 operations, but the money was spent in vain and vets were forced to amputate. Lily didn’t require a prosthetic limb, making do instead on one leg. Apart from falling over occasionally when scratching, she has managed well.

Lily was diagnosed with depression shortly after losing her leg, due to separation anxiety during the day when the Mills’ were at work. Treatment was straight-forward. TV. All day, every day. She quickly returned to good health and resumed laying eggs.

The vet who diagnosed depression was not available for comment.

One of her important points is that it takes an awful lot of work to get better and then stay well. I agree wholeheartedly. It seems that those who actively participate in their treatments have the most success in returning to and maintaining good health. They are active in learning about the illness, in locating resources, in finding the right treatments, and they are determined to pull things around. It doesn’t help to be passive about depression.

Therese’s experience of nearly giving up on traditional medicine rings true. For the first few years of being treated my family doctor experimented with various drugs with little success. I was fortunate to find a great psychiatrist on my first attempt, but it involved a good dose of my own research. When my doctor suggested a psychiatrist I declined and asked him to refer me to the one I had chosen. I know that most people don’t have the time or inclination to do this, but it was important for me as the point in which I became active in my treatment. I had been labeled “treatment resistant” for too long.

I would point out that when medicines are used it is not just about finding the right drug or mix of drugs, but also making the right diagnosis in the first place. This sounds very basic but misdiagnoses are very common. It is awful being treated for the wrong mood disorder.

Therese has developed her system very purposefully. Remaining healthy requires a plan; much more than passive acceptance. I definitely suggest you try her 12 steps, with some shaping to suit.

Albert Foong presents “The Elusive Key to Emotional Mastery: Is it Really that Simple?” posted at Urban Monk. This is by far the longest post I’ve ever read, but I’m glad I did since it’s given me plenty of food for thought. It may be particularly helpful if anger or irritability is your main symptom of depression.

Romeo Vitelli presents “When Dying Becomes Fashionable” posted at Providentia, saying, “When suicide follows a trend”. It’s a well-written, interesting and informative article on an unpleasant subject – copycat suicides.

Edith Yeung presents “I Have a Dream” posted at EdithYeung.com, saying “I think this video will help anyone who has depression.” I was skeptical when I saw the You Tube player, but this is simply brilliant!

Shaheen Lakhan presents “New Tool to Diagnose Adolescent Depression“posted at GNIF Brain Blogger. This article really caught my attention. It discusses a new dimensional diagnostic tool in which adolescent depression is graded on a scale from mild to severe. My problem is that “depression” is a catch-all word describing a broad spectrum of mood disorders, including melancholic (biological) and non-melancholic depression. Treatment problems arise when depression is treated as a single illness that just differs in severity. It will be interesting to hear more about this new diagnostic tool.

Alvaro Fernandez presents “Working Memory Training from a Pediatrician Perspective, Focused on Attention Deficits” posted at SharpBrains, saying, “An interview with one of the pioneers of working memory training, and a related discussion on the implications for health and education.” This is an interesting interview, relevant to any parent of a child with an attention deficit.

That concludes this edition. Submit your blog article to the next edition of carnival of depression, bipolar disorder using the carnival submission form. Past posts and future hosts can be found on the carnival index page.

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It raises the question of how much people with severe depression would pay to eliminate their illness. With or without side-effects. Very interesting question!

A quick, birds-eye view of the study, and then on to my own questions.

Firstly, the purpose of the study isn’t entirely theoretical; amongst other things it assesses individual preferences for different treatment programs, and examines the effects of depression on the pleasure derived from consuming goods (a major concern for our economy centered societies).

The survey was conducted with 104 individuals recently diagnosed with Major Depressive Disorder. These respondents indicated their preferred treatment choices according to an array of options: hours of psychotherapy per month, use of anti-depressants, cost of treatments, side effects (weight gain, loss of interest in sex, inability to orgasm) and no treatment.

The study found a willingness to pay a large amount to eliminate depression, but the amount fell substantially in the absence of, or with much reduced, side effects. The study also found that depression has a negative impact on pleasure from consumption which worsens with severity, as you would expect.

The study concludes that willingness to pay should be included in any cost-benefit analysis of how additional resources can be allocated to treatment alternatives, and that the kind of estimates gathered from the survey could provide a process for better matching treatment programs to patients.

These are the two questions that I’m compelled to ask you:
“How much would you give up to get rid of depression?” and
“How much would you have to be given to keep it?”

I need a day or two to think about this!