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The DSM-5 criteria for Major Depressive Disorder are extremely broad. Many serious, thoughtful psychologists and psychiatrists believe that we are at real risk

The DSM-5 criteria for Major Depressive Disorder are extremely broad. Many serious, thoughtful psychologists and psychiatrists believe that we are at real risk of pathologising normal human emotion. Code 296.21 designates the apparently paradoxical diagnosis of Mild Major Depressive Disorder, with the following description of severity: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning. Essentially, the DSM-5 creates a specific diagnostic category for people who are basically OK but slightly sub-par. That's not inherently dangerous in isolation, but it does interact very dangerously with the persistent malpractice of the pharmaceutical industry. Someone who might just need some low-intensity psychotherapy or some peer support might end up on an indefinite SSRI prescription. Several meta-analyses have indicated that SSRIs are not significantly more effective than placebo in mildly depressed patients, with a significant frequency of adverse events. Most SSRIs have known "discontinuation effects" (e.g. withdrawal symptoms), making SSRIs a distinctly questionable choice for mild or short-term depressive episodes. Despite this, there has been a vast increase in the number of SSRI prescriptions, with most of the growth occurring in patients who historically would not be considered sufficiently impaired to warrant drug treatment. 10% of Americans over 12 are currently taking antidepressants, rising to a staggering 23% of middle-aged women according to the National Center for Health Statistics. There is a huge racial disparity, with 13.6% of non-Hispanic whites taking antidepressants versus 3.9% of non-Hispanic blacks. Less than a third of people taking a single antidepressant have seen a mental health professional in the past year. Something is seriously wrong with the way we diagnose and treat depression; I lay the blame almost entirely at the door of pharmaceutical marketers. https://www.cdc.gov/nchs/data/databriefs/db76.htm https://www.cdc.gov/nchs/data/databriefs/db76.htm

bonesss 9y ago
> The DSM-5 criteria for Major Depressive Disorder are extremely broad. You're making a justified/not justified appeal to the scope of diagnosis, not that diagnosis exists/does not exist on the basis of "reasons". As a taxonomy the code system in the DSM is broad, inclusive, and tries to hit a meaningful subset of behaviour in range of darned tricky, poorly defined, near-impossible to STEM-style research, and abuse prone issues. More importantly, the reason there will be a DSM-6, DSM-9, and DSM-111 is because these codes will specialize and refine themselves over time... > Essentially, the DSM-5 creates a specific diagnostic category for people who are basically OK but slightly sub-par... might end up on an indefinite SSRI prescription. The fact that a diagnosis exists or not is orthogonal to treatment method. The DSM is like the Dewey Decimal system of "head stuff", inclusion in it's indexing is proof and support only of inclusion in its index. Mein Kampf is as much a book as my self-published wookie fan fic, IOW ;) Crappy medication from crappy doctors is a big deal, and crappy use of prescriptions kills a lot more people than any of the fun drugs... Regardless, bad treatment or good treatment do not hinge on subjective qualitative judgements of your experiences. That's how priests operate, not doctors. > Something is seriously wrong with the way we diagnose and treat depression; The US is a notorious abuser of pharmaceuticals across the board, with notoriously bad diet, nutrition, weight, and health system... Something is seriously wrong with the way you treat all your sick people, and design your cities, and make your food, and treat your environment... There is especially something wrong with how you advertise pills constantly as though they can heal with powers otherwise reserved for healing lepers and converting water into nicely refined chianti... This still doesn't mean you are only by-textbook-defition depressed if you have a "reason". You don't have to justify leukaemia, schizophrenia, bulimia, aspergers, or chronic asshole-itis, why should depression be any different? If you're statistically abnormal, you're statistically abnormal. No one in crushing pain needs to convince, debate, warrant, or validate anything for a doctor and healthcare system to understand that their anamnesis correlates with a particular taxonomy. In fact, that's kind of a jerky thing to demand of someone experiencing psychic distress and looking for help...

bonesss 9y ago

> The DSM-5 criteria for Major Depressive Disorder are extremely broad. You're making a justified/not justified appeal to the scope of diagnosis, not that diagnosis exists/does not exist on the basis of "reasons". As a taxonomy the code system in the DSM is broad, inclusive, and tries to hit a meaningful subset of behaviour in range of darned tricky, poorly defined, near-impossible to STEM-style research, and abuse prone issues. More importantly, the reason there will be a DSM-6, DSM-9, and DSM-111 is because these codes will specialize and refine themselves over time... > Essentially, the DSM-5 creates a specific diagnostic category for people who are basically OK but slightly sub-par... might end up on an indefinite SSRI prescription. The fact that a diagnosis exists or not is orthogonal to treatment method. The DSM is like the Dewey Decimal system of "head stuff", inclusion in it's indexing is proof and support only of inclusion in its index. Mein Kampf is as much a book as my self-published wookie fan fic, IOW ;) Crappy medication from crappy doctors is a big deal, and crappy use of prescriptions kills a lot more people than any of the fun drugs... Regardless, bad treatment or good treatment do not hinge on subjective qualitative judgements of your experiences. That's how priests operate, not doctors. > Something is seriously wrong with the way we diagnose and treat depression; The US is a notorious abuser of pharmaceuticals across the board, with notoriously bad diet, nutrition, weight, and health system... Something is seriously wrong with the way you treat all your sick people, and design your cities, and make your food, and treat your environment... There is especially something wrong with how you advertise pills constantly as though they can heal with powers otherwise reserved for healing lepers and converting water into nicely refined chianti... This still doesn't mean you are only by-textbook-defition depressed if you have a "reason". You don't have to justify leukaemia, schizophrenia, bulimia, aspergers, or chronic asshole-itis, why should depression be any different? If you're statistically abnormal, you're statistically abnormal. No one in crushing pain needs to convince, debate, warrant, or validate anything for a doctor and healthcare system to understand that their anamnesis correlates with a particular taxonomy. In fact, that's kind of a jerky thing to demand of someone experiencing psychic distress and looking for help...