The Great "Depression" Epidemic

Aidan Munoz 

Professor Horgan 

Seminar in Science Writing 

28 February 2024 

The Great “Depression” Epidemic 

Suicide. Worthlessness. Insomnia. The symptoms and effects of depression can cause these issues to be extremely prevalent thoughts in one’s everyday life. According to the National Institute of Mental Health, in just the year 2021, an estimated 21 million adults in the United States had at least one major depressive episode. With growing knowledge and information on what the implications and impacts of mental health issues mean for a person, it becomes essential to acknowledge the possibility of overdiagnosis. With depression estimated to be the most common mental disorder in the world, the prescribed “solutions”, generally of pharmaceuticals and therapies, can either bring further help or harm to a believed diseased person. 

If depression is so common, how common is the overdiagnosis of it? Associate professor with the Johns Hopkins Bloomberg School’s Department of Mental Health, Ramin J. Mojtabai, authored a study declaring that “Depression over-diagnosis and over-treatment is common in the U.S. and frankly the numbers are staggering”. For his methodology, Mojtabai used a national sample of 5,639 participants who had been diagnosed with depression in a non-hospital setting by a clinician between 2009 and 2010. Their re-evaluations were done in face-to-face interviews, having to meet the criteria of having experienced a major depressive episode for at least two consecutive weeks in the past year to date. Of this group, only 38.4% were re-evaluated to have had a major depressive episode in that time frame, fitting the criteria for major depressive disorder (MDD). For adults 65 or older, only 14.3% met this criterion. Mojtabai believes that the possible causation for this upward trend in overdiagnosis is a response to years of underdiagnosis and undertreatment that has cost the well-being and lives of countless people. These “false positives” may serve as notions that the criteria and understanding of what is more often referred to as “minor depression” or “sub-threshold syndromes” are shrouded in ambiguity and uncertainty, pushing clinicians to rather be “safe” than sorry. Fearing that, when medication is involved, our society will devalue someone’s suffering if a “solution” is not provided, often using pills before resorting to non-medical responses. 

How dangerous is overdiagnosis really? With the risk of overdiagnosis, certain individuals may be exposed to psychotropic medications early on, risking side effects and long-term health risks. For example, in Dr. Mojtabai’s study, 75% of all participants reported using prescription medications for their symptoms, with 69.4% of those with unconfirmed diagnoses having used antidepressants. This creates a critical issue that urges our society to emphasize excessive medicalization of distress and risk undermining resilience-building and coping strategies, perpetuating an idea of dependency on pharmaceuticals. According to Harvard Health Publishing, from Harvard Medical School, antidepressants can cause insomnia, skin rashes, joint and muscle pain, nausea, a slight risk of internal bleeding, and possibly even increased thoughts of violence or self-harm. With a discontinuation of the drug’s use possibly leading to a “withdrawal reaction” of blurred vision, insomnia, fatigue, burning, nausea, and so on. Scientia Professor of Psychiatry at the University of New South Wales, Gordon Parker, has stated for the National Library of Medicine, “trials in major depression show minimal differences between antidepressant drugs, evidence based psychotherapies, and placebo. The benefit of treatment for the minor and subsyndromal depressions is even more unclear.” In his research, he has made clear that there is a favoring of antidepressant drugs over placebo for melancholic depression, a specific subsection of major depression, but not for the general illness. The cause of this issue is likely the combination of under-diagnosis and treatment of those in need with over-diagnosis and treatment of those who don’t need the same level of treatment which deteriorates our understanding of diagnosis targeting and proper treatment of major depression. 

The overdiagnosis of depression cannot be separated from its broader social and cultural context. Cultural norms and values have shaped perceptions of mental health and have damaged a lot of help-seeking behaviors. Socioeconomic disparities and systemic inequalities amplify disparities in mental health diagnosis and treatment. Certain groups, such as minorities and marginalized communities, may be disproportionately affected by overdiagnosis and underdiagnosis, perpetuating health inequities. To prevent overdiagnosis and deliver patient-centered treatment, clinicians must critically analyze diagnostic criteria, conduct thorough assessments, and take the patient's life context into account. Preventive treatment, early intervention, and comprehensive approaches to mental health that address social causes and foster resilience must be given top priority by healthcare institutions to work towards resolving this issue. Positively, this openness to understanding the major issues brought to the forefront by mental illness have allowed negative stigmas around the topic to evaporate slowly over time. It has led to the removal of additional barriers to entering the workforce, increased access to life insurance, and reduced secondary alcohol and drug misuse. However, as we abandon these demeaning qualities, we open the door to over diagnosing and putting those who aren’t initially at risk, at risk in the future. By no means do I mean to undermine how depression treatment has reduced suicide rates and increased societal productivity, but I do wonder what too much overcorrection may do to the minds and health of individuals who only needed some guidance. 

In essence, overdiagnosis of depression is a complex problem having broad effects on patients, medical systems, and society at large. It emphasizes the necessity of critically analyzing current diagnostic procedures, raising awareness of the social factors of mental health, and creating more sophisticated methods of evaluation and therapy. We can lessen the negative effects of overdiagnosis and advance a more compassionate and fair approach to mental healthcare by encouraging mental health literacy and supporting policies that give priority to holistic well-being. 

 

Works Cited 

“Major Depression.” National Institute of Mental Health, U.S. Department of Health and Human Services, July 2023, www.nimh.nih.gov/health/statistics/major-depression.  

“Over-Diagnosis and over-Treatment of Depression Is Common in the U.S.” Johns Hopkins Bloomberg School of Public Health, 30 Apr. 2013, publichealth.jhu.edu/2013/mojtabai-depression-over-diagnosis-and-over-treatment.  

Parker, Gordon. “Is Depression Overdiagnosed? Yes.” National Library of Medicine | National Center for Biotechnology Information, 18 Aug. 2007, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949440/. 

“What Are the Real Risks of Antidepressants?” Harvard Health, 17 Aug. 2021, www.health.harvard.edu/newsletter_article/what-are-the-real-risks-of-antidepressants. 

 

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