Posted by: Ranveer Bassey24 MAR 2013
Pharmacists dispensed £270million worth of happiness in2011, with 1 in every 20 items dispensed being an antidepressant. It worries me a little.
There exists a no-man's land inmental illness diagnosis. On one sideare the clearly well, functioning and content individuals. On the opposite are the clearly unwell. The latter are relatively easy todiagnose. Their symptoms, such ashearing voices, are analogous to the broken leg on an x-ray allowing for almostundisputable diagnosis. It's the peoplein the middle I worry about.
When does an emotional responsebecome a symptom? When does a person becomea patient?
Psychiatrists use diagnostictools like the DSMto help answer these questions. It listssymptoms associated with different illnesses. If you haven't read a copy, I recommend you do. By the time you've finished, you'll find youhave at least five different mental illnesses. The subjectivity of the criteria makes it so. Diagnosis seems almost an art form.
But I don't think thedifficulties with diagnosis particularly matter. The outcome for patients does. But we pass the diagnosis problem only to hitanother, because I don't think a diagnosis of depression and the requisitescript for an SSRI helps.
You can understand why GPsprescribe so readily. For the GP, thepatient walking in is their starting gun. You don't hear it, but in the background there is a clock ticking. It ticks with the potential anger of tens ofpatients with late appointments. Itisn't the time for GPs to hear worries. It's the time for patients to fill in a questionnaire, be scored andleave clutching prescription in hand.
I get the impression pharmacistshave a general sense of unease about the number of antidepressants theydispense. It seems similar to the uneaseonce (still?) felt about antibiotic prescribing. We now know this was well-founded, with advertising campaigns currentlyinforming patients that "antibiotics won't help". Let's hope we don't see similar posters aboutantidepressants.
Perhaps the current approach isthe wrong one. Maybe mild depressionshould be treated the same as other mild, or minor, ailments. Imagine a section in a pharmacy, like thehayfever section, with non-pharmacological treatments. I'm not talking about chakra rebalancing orother new-age nonsense, but evidence based approaches, the likes of cognitivebehavioural therapy.
A shift in approach to milddepression away from diagnosis and disease, towards self-care in the spirit ofself-improvement, would clearly be more positive and empowering.
Pills may not be the answer, butpharmacy can still be a part of the solution.