Sunday, September 02, 2007

My Three Shrinks Podcast 32: Doctor Anonymous on Depression Overdiagnosis


[31] . . . [32] . . . [33] . . . [All]

Today's podcast features a guest, Doctor Anonymous, who joined us via Skype. DrA is a midwest US primary care physician who blogs about medicine and health care. We've been trying to get him on for a while, but call schedules and such just didn't align. We both had Skype set up, I added Call Recorder (which allows you to easily record both sides of the conversation, each on a different channel), and it went off without a hitch.
DrIzzy from Michigan added a complimentary iTunes review (thank you), but he commented on our sound levels, which we agree are sometimes subpar. He points out that, since we have made the podcasting "big time" (LOL), we should get us some grown-up sound equipment. Now we are using a single Snowball microphone with the high-gain patch (mentioned in Podcast #3), which is sometimes doesn't pick up Clink and Dinah as well. So, we are thinking about getting a mixer and some lapel condenser mics. Let us know if any of you have suggestions about this. I'd like to add a couple Google ads on the sidebar to help pay for it; Dinah is equivocal. Let us know what you think. (Oh, the bird in the background is Monkey, my parakeet.)

Oh, and I see that DrA has started a call-in show! Check out the first one here.
-Roy



September 2, 2007: #32 Doctor Anonymous on Depression Overdiagnosis



Topics include:
  • DrA on Skype (not a soundboard). Dinah relished the memory of Podcast #24. Check out DrA's blog, doctoranonymous.blogspot.com.

  • Is Depression Overdiagnosed? We discuss two point-counterpoint pieces in the August 18 2007 issue of BMJ (British Medical Journal). The YES piece is written by Gordon Parker, who believes there is a trend to turn "sadness" into a medical condition: "The ease of assigning a diagnosis of clinical depression, even of major depression, has rebounded on psychiatry, blunting clarification of causes and treatment specificity."

    The NO piece is written by Ian Hickie, who argues that despite the benefits of increased rates of diagnosis, many people with depression continue to go unrecognized, untreated, and impaired: "The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care."

    Find online comments on these articles at BMJ's website here.

  • Further discussion about the symptoms of major depression, subsyndromal depression, dysthymia, substance abuse, the influence of the pharmaceutical industry, depression screening, access-to-care problems, inpatient bed capacity problems, per capita psychiatrists and psychologists, stigma about mental illness, primary care management of depression, emergency evaluations.

  • We digress into hot McDonald's coffee, Twinkies, and chocolate.







Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well.

This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.
Thank you for listening.

11 comments:

Dr. A said...

Thanks so much for the opportunity. I hope people don't get sick of my voice with my show last week and this podcast. Yeesh!

Speaking of microphones, I was formerly using the snowball (just because it looked so cool). Now, I'm experimenting with logitech headphone/mic units.

People told me that they had trouble with the sound level on my show. I was considering investing in a "real microphone" (meaning studio grade) and also a mixer device, but I'm undecided right now.

Rach said...

Dr. A + 3 shrinks. It's like a blog-cast dream came true! haven't listened to the podcast yet, but it's downloading as I speak!

Enjoy the last 32 hours of the long weekend...

Aqua said...

Interesting podcast. Thanks. I guess my question is...If there is so much overdiagnosis going on, why then did it take my the G.P's I saw approximately 15 years to diagnose me, and another 2 to refer me to a psychiatrist? I know others where this has happened too, so I'm not the only one.

I suspect part of the problem might be the atypical nature of my depression...I can be "up" and "sociable" for short periods when I have to...and authority figures tend to make me feel like I need to perform, but still I had many of the "physical" markers for depression everytime I went to see my family Dr...not sleeping, fatigued, gaining weight/and or losing weight, constant worrying (I expressed to my G.P when I was 23., "It is like I have a negative feedback loop stuck on replay inside my head"), ...crying!

...yes I cried almost everytime I was at the Drs...and no one clued in that I might be depressed? I don't get it. How does that happen?

yay said...

My first comment is that Prof Hickie and Prof Parker are heads of the two "rival"* brain-stuff research institutes in Sydney. And they are also based at the two big, rival Sydney medical schools! Although Professor Hickie was previously at UNSW so we (at USyd) can never be too sure where his true allegiances lie....

* By rival research institutes, I'm sure they don't hate each other, just that they would be competing for the same research $$ and big name scientists.

I actually agree with some aspects of both sides as (I think... it didn't sound like Dr A!) Roy was saying - there is both under and over diagnosis of depression, in different populations. And over and under treatment. And I agree with (I think) Clink that semantics is a big part of the argument.

Regarding depression being "the new black"... I'm not sure that's the case. In some populations it is indeed quite acceptable to be "in therapy". Whether it is acceptable to be unable to get out of bed, not eating, thinking about dying... is a different matter.

In a discussion on another website, Professor Parker was criticised for "denying treatment to those who need it". Which, in my opinion, is garbage. He is all for promptly treating people who need it, and finding the most effective treatment for those people.

Handing out antidepressants to EVERYONE who presents to a GP with mild symptoms of short duration seems to be where the problem lies.

I think it's partly a resources/funding thing, and partly an attitude thing. In Australia, the resources/funding thing is actually in a rather interesting situation - mental health has been granted a pot load of money recently, but there aren't enough human resources to spend it on. A big jump forward has been the recent inclusion of psychologists under Medicare (ie. they are now subsidised). HOWEVER the problem is that the GP referral paperwork takes a long time - longer than a normal GP consultation. It's much less paperwork to refer to a psychiatrist! And even less paperwork to prescribe an SSRI...

Sarebear said...

I just caught up on podcasts last night. It was AWESOME to have Dr. A in your 'cast.

I'm sorry I missed Doc A's live one, though; of course, I can listen to it after the fact, and I will!

I'm glad you three are back, and look forward to the variety of subjects, perspectives, opinions, and stuff that you bring us!

A Mom Who Thinks Too Much said...

I enjoyed this podcast (and Dr. A's BlogTalk, too)! Some thoughts:

1-You talked about the negative perception people often have about psychiatry. I certainly shared that lay public view before finding this blog, but feel differently now. A kinder, lighter, and more informed view of psychiatry comes across in a very credible way here (in a "grass roots" way). I can't speak for patients, but as a member of the general public, I am edified.

2-I would love it if you would talk more about the addictive qualities of dark chocolate. And if there are rehab centers for that.

3-I didn't hear Roy's bird, Monkey, in the background--can you put him on next time?

Thank you.

Dinah said...

Dear Thinking Mom: Please don't worry, during upcoming podcast with Dr. Mark Komrad talking about psychiatry in the movies, that Monkey did not shut up.

Anonymous said...

In the podcast, Dr. A said that one of the reasons why depression is overdiagnosed is because of lack of personal responsibility.

Seems like this means that you're damned if you do seek a diagnosis and damned if you don't. If you don't, you take personal responsibility, but you can't break through the wall of the depression because you're spending so much time feeling guilty about all the things you aren't doing while you're lying in bed crying. If you do, then you're abdicating personal responsibility by claiming that you were lying in bed crying because of an illness called depression. Which makes you feel guilty all over again.

How is the person diagnosed with clinical depression supposed to break through the cycle described above?

Dinah said...

"Depression" as in Clinical Depression, to be distinguished from depression--the transient feeling of sadness-- is characterized by a constellation of symptoms that include:
Pervasive lowering of mood
Loss of interest
Lack of ability to feel pleasure
Undo feelings of guilt
Fatigue
Change in appetite
Disruption of sleep, often mid or early awakening
Loss of sex drive
Wishing for death to come
Thinking about suicide
Slowness of thoughts and movements
Colors may look duller
Unexplained aches and pains
Crying
Ruminations
Trouble concentrating
Loss of motivation
Delusion of impending doom
Hearing derogatory voices

...to name a few. You don't need all those symptoms to have a diagnosis of depression, a few will do, and so someone who is lying in bed, not partaking in life, crying and feeling guilty, presumably with pervasive sadness, is likely depressed and my personal and humble opinion is that getting help may well make a HUGE difference in this person's quality of life.

The issue of Over-Diagnosis comes when someone tells their doc "I'm depressed" and the doc doesn't do a full history and prescribes meds without a full assessment and a clear idea of what symptoms the medication is targeting.

Anonymous said...

What happened to no anonymous comments?

Emily said...

Greetings, Any thoughts on physician depression and suicide, and the implications for student training? See Newsweek article "Doctors Who Kill Themselves" by D. Noonan 4-28-08. It's covering the PBS "Struggling in Silence" special.