The great depression swindle - British tests for depression worse that useless

As seen in the Daily Mail

The test GPs use to diagnose depression is worse than useless, according to new research. Under the latest government guidelines, doctors are paid extra to ask patients two simple questions. Your answers are supposed to show if you are depressed or not.

But, a study has found that 62 per cent of patients diagnosed as depressed weren't in fact depressed at all.

As a result, doctors and psychiatrists could be seriously over-estimating the number of people who are depressed - and prescribing drugs to thousands who are healthy, says the study's author, Dr Alex Mitchell, a consultant psychiatrist at Leicester General Hospital.

Under current guidelines, with mild to moderate depression are meant to be offered talking therapies - psychological treatments which help people change their attitudes or behaviour patterns.

Research by the mental health charity SANE has found that only [...] two per cent of patients were having cognitive behavioural therapy (CBT) and more than 80per cent of patients were being treated with medication.

Anti-depressants come with a range of side-effects. About 25 per cent of patients have problems when they try to stop taking them and studies have found they can cause a rise in suicidal thoughts and actions. Patients also report a loss of libido.

Two recent studies have linked the drugs with a drop in bone density leading to osteoporosis and a dramatic fall in the number of sperm a man can produce.

Given all this, you would expect those two questions, approved by the National Institute for Clinical Excellence (NICE) in 2004, to be exacting.

In fact they are absurdly simplistic and, worryingly, if you answer yes to both you could be put on Prozac.

The two questions are:

• During the past month have you been bothered by feeling down, depressed or hopeless?
• During the past month have you been bothered by having little interest or pleasure in doing things?

The GPs' two-question test isn't the only one the experts have got badly wrong. Dr Mitchell's other shocking discovery is that the latest guidelines to detect post-natal depression (PND) are even more inaccurate, but in the opposite direction.

A new three-question test fails to spot an astonishing 80 per cent of the women who actually are depressed.

"It uses the same two questions as for regular depression and then adds a third: "Do you want help?" This reduces the accuracy of the test to just 17 per cent," explains Dr Mitchell.

NICE is now in discussion with Dr Mitchell about the PND test.

According to the doctors' newspaper Pulse, many GPs are dropping the depression test because they don't believe it is good for patient care, even though they will lose income as a result. It's mainly aimed at high risk patients, such as those with heart disease or diabetes.

Many GPs say they don't have the time for longer, more accurate testing - the reason for introducing the shorter test in the first place.

The useless tests also threaten to make a nonsense of a new government initiative to make CBT available to many online.

Last year, a group of charities, including the Mental Health Foundation and Mind, called for a "large sustained cash injection to improve psychological treatments'.

They said CBT was as effective as drugs and that more than half of GPs believed it was the best option.

The internet scheme, unveiled by Health Secretary Patricia Hewitt last month, has been designed to meet criticism that, even though CBT is recognised as the best treatment for depression, waiting times can be more than a year because the health service needs 10,000 more therapists.

If you rate as depressed on the flawed test, you get eight onehour interactive computer sessions on a program called Beating The Blues with homework projects and GP progress reports - much cheaper than training 10,000 therapists.

The aim, said Ms Hewitt, was to allow patients to access the right sort of therapy "instead of just being prescribed medication".

One doctor who has been using the system in Swindon, Wiltshire, for three years was enthusiastic.

Dr Peter Crouch said: "It has significantly helped patients cope with anxiety, insomnia and stress." But, of course, how useful it is depends on how accurately people are diagnosed.

Indeed, what is the point of rolling out a programme that will be offered to hundreds who don't need it - or if it isn't provided to those who do? Soon many will be spending hours at their keyboard doing CBT exercises for no reason.

The 'good' news is that computers and the internet are likely to be much more widely used to spot who needs help - and at least these seem more accurate than the two-question test.

A recent report by researchers in Taiwan reported that an online questionnaire filled in by more than 500 people identified 38 per cent as depressed and 46 per cent as not. When they were tested by a psychiatrist, 75 per cent of the diagnoses were correct.

Soon patients may be asked to fill in longer questionnaires of this sort, while they are in the waiting room.

And if it is done on a computer the doctor could then have the results during the session. For the moment, what can you do to increase your chances of getting the right sort of help?

Dr Mitchell's research into how GPs diagnose depression also provides some useful tips. "Doctors tend to be influenced by how patients describe their problems," he says.

"If you talk about physical symptoms - how tired you are, how you can't sleep - your doctor will usually suspect a physical cause even though those are also signs of depression.

"Be clear about your main symptom. So if feeling down or low is what's really making your life miserable, talk about that."

How can you avoid being labelled as depressed when you aren't? Do what may seem like common sense and explain your problems.

What the test ignores is that sometimes people have a very good reason to feel low: you've been sacked, for example.

A recent U.S. study has found that as many as a quarter of people currently labelled as depressed are reacting perfectly normally to stressful events.

It suggested that even psychiatrists regularly miss the broad picture. Once you've ticked enough boxes for symptoms, you get diagnosed as depressed even though you may just be sad.

So if you aren't asked the obvious question about what is going on in your life, make sure you volunteer it.