Depression Diagnosis Difficulty

Depression was overdiagnosed and overtreated in primary care settings

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Doctors may be overdiagnosing depression in some, but then underdiagnosing it in others. Misdiagnosis can lead to patients taking the wrong medications and not receiving the right treatments.

In a recent study, a researcher interviewed a group of people that had been diagnosed with depression in a primary care setting.

The results of the study showed that only about one-third of the patients really met the criteria for clinical depression.

"Seek a therapist for help with depression."

Ramin J. Mojtabai, PhD, associate professor in the Department of Mental Health at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, MD, looked at cases of patients that had been diagnosed with depression to see if they actually met the clinical criteria for a depression diagnosis.

For the study, Dr. Mojtabai interviewed 5,639 people that had been diagnosed with major depressive episodes in a general, community medical setting, rather than a mental health setting, between 2009 and 2010.

Dr. Mojtabai used the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), to diagnose clinically significant symptoms for major depressive episodes.

Dr. Mojtabai found that only 38 percent of the 5,639 individuals met the DSM-IV criteria for major depressive episodes. Further, only 14 percent of participants 65 years of age or older met the criteria for a diagnosis for depression.

People were more likely to have depression if they were unemployed, single or divorced, more educated or in poor health (self-rated).

Of the participants who did not meet the criteria for major depressive episodes in the past 12 months, 23 percent met the criteria for major depressive episodes within their lifetime and 24 percent met the criteria for minor depression within their lifetime.

These numbers mean that nearly half (43 percent) of the people who did not meet the criteria for major depressive episodes in the previous 12 months did not, in fact, meet the criteria for any lifetime depressive diagnosis.

Participants that did not meet the criteria for major depressive episodes were less likely than those who met the criteria to have trouble functioning in society and in the workforce and used fewer mental health services.

Dr. Mojtabai found that 84 percent of participants with a confirmed diagnosis for depression, and 74 percent of those without a verified diagnosis for depression, were prescribed psychiatric medications.

Dr. Mojtabai suggested that overdiagnosis and overtreatment of depression has been at least as common as underdiagnosis and undertreatment of depression.

Dr. Mojtabai suggested that the increasing role of primary care settings for all types of medical conditions has created a need for improvements in the diagnosis and treatment of depression and other mental health disorders in those settings.

The cost for a visit to a mental health specialist can vary widely based on location and insurance coverage. Costs may range between $0 to $150 per visit.

This study was published in April in Psychotherapy and Psychosomatics.

No outside funding was used to support this study. Dr. Mojtabai reported receiving consulting fees from Lundbeck pharmaceutical company. No conflicts of interest were declared.

Reviewed by: 
Review Date: 
May 5, 2013
Last Updated:
October 28, 2013