Tougher definition for depression 'poses suicide risk'

More people are likely to fall seriously ill with mental health problems that could lead to suicide if the clinical threshold for depression is raised, mental health experts warn.

Marjorie Wallace, the chief executive of the mental health charity SANE, was responding to a comment by a leading psychiatrist who has argued that too many people are being diagnosed with clinical depression.

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Professor Gordon Parker of the University of New South Wales in Australia said that it is normal to feel depressed at some time in your life, that the definition of clinical depression is too loose and as a result it draws in too many people.

Ms Wallace said yesterday that the early diagnosis and treatment of depression is essential for a number of people as it could lead to suicide. "It is better to risk over diagnosis than to leave a person untreated. One in 10 people with severe depression may take their own life," Ms Wallace said.

"Depression can be a complex and challenging condition ranging from feeling low to being so disabled that the person may be unable to get out of bed in the morning, sustain relationships or work," she said. "It is not surprising that with such a wide range of symptoms, identification varies from one doctor to another.

"We've been campaigning for a long time to get people to talk to their doctor earlier, so we don't want the seriousness of the illness trivialised. This also explains why the rate of diagnosis has increased as people come forward.

"It fits with the World Health Organisation's prediction that by 2020 depression will be the second greatest global burden of disease after chronic heart disease." Ms Wallace said that not enough money was being put into "talking cures" so doctors were being forced to over-prescribe anti-depressants for low level depression. "Doctors ... can give people with mild to moderate depression anti-depressants which are shown to work in about 70 per cent of cases, or they can put them on a waiting list for a talking therapy, which ... really should be used first.

"But the waiting lists can be many months, even a year long for cognitive behavioural therapy [CBT] because there aren't enough trained therapists. We've welcomed the Government's promise that within 10 years there will be 10,000 new psychologists who will be giving CBT to people with mild to moderate depression."

In an editorial in the British Medical Journal, Professor Parker said that in 1980 the rules on how depression was diagnosed were changed and this has led to a huge increase in the number of people taking medication and the "medicalising" of normal emotions. Qualifying symptoms included "feeling sad, blue or down in the dumps" for two weeks, or appetite change, sleep disturbance, drop in libido and tiredness. Professor Parker said that most people have these at some point in their lives.

He called depression a "catch-all" diagnosis driven by clever marketing that supported a thriving prescription-drug industry. There was an over-reliance on anti-depressants, which were being marketed beyond their "true utility", he said.

However, Professor Ian Hickie, the executive director of the Brain and Mind Research Institute at Sydney University, said the revision of how clinical depression is diagnosed has removed the old stigma surrounding mental illness.

"From a health and economic perspective, we can give a clear answer - more adults are alive and well and we can easily afford to treat more. Increased treatment of depression reduces suicides and increases productivity," he said.

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