Understanding Depression Diagnosis: A Different Perspective
Many individuals think that diagnosing clinical depression is all about objective tests, like blood tests or brain scans. However, Dr. Josef Witt-Doerring challenges this notion, suggesting that it’s not quite as straightforward as that.
He points out that when diagnosing depression, people are asked to select from nine symptoms. So, if you find that maybe five of those symptoms resonate with you—like feeling down, anxious, having trouble sleeping, or feeling guilty—then you’re categorized as depressed. It’s a somewhat arbitrary list, he argues. “Those symptoms resonate for people with depression, and the diagnostic manual simply states that having five out of nine means you have depression,” he explains.
This approach raises questions about the quality of care regarding depression. “In the U.S. and many Western countries, family medicine is facing a significant challenge. Depression is so prevalent that 80% of prescriptions for it come from family doctors,” Witt-Doerring notes.
He adds, “Doctors are incentivized to see patients quickly, which means the focus often turns to just making a diagnosis. If you can see one patient every hour instead of four, well, you’re increasing your earnings quite a bit by seeing fewer patients in that same timeframe.”
The history of selective serotonin reuptake inhibitors (SSRIs) also raises concerns. In the 1950s, a drug initially used to treat tuberculosis was found to have mood-enhancing side effects. “They realized patients were more energetic while taking it and thought, perhaps this has antidepressant effects. They then prescribed it to those with depression, and it showed some success,” he explains.
However, as the narrative evolved, two interpretations arose. One was that these drugs energized patients and that’s what helped them. The other suggested that depressed patients had imbalances in serotonin, norepinephrine, and dopamine, implying that the drugs effectively addressed these issues.
“Unfortunately, the latter interpretation stuck, mainly because it has commercial appeal,” he says, remarking that extensive studies comparing the brains of depressed and non-depressed individuals failed to identify a singular biomarker, indicating that the drugs might merely be masking symptoms rather than curing depression.
“It’s easy to argue morally about these issues, but many people just want to feel better amid their suffering. And that feeling is completely understandable,” he acknowledges.
Yet, the message conveyed about these medications can be misleading. “We don’t emphasize enough that these are still drugs that can lose effectiveness over time. Our brains aren’t accustomed to long-term usage, which comes with risks,” he explains. “That’s, well, a significant oversight in the conversation surrounding these treatments.”
