Iain Kewley wrote:
>
> Graham,
>
> You wanted UK references? There are some US ones at the end too,
>
> Iain
>


Many thanks. These are useful. But they do not counter my point for the
reasons set out below.

Of course,in any event,  what these studies do not tell us is the other
side of the coin, ie  how many people are "treated" for a depression
when not truly depressed at all. I have not disputed that there may be
many truly depressed patients not diagnosed as such by their GPs until
they present to a psychiatrist (presumably mostly becaus ethey failed to
visit or tell their doctors sufficient) but I am not sure how that helps
the issue with which I am dealing. If something is not right, it is
irrelevant how small is the incidence so long as it is not
insignificant. My view is that GPs treating patients with
anti-depressants when they really have a life situation to be looked at
first is not insignificant.

One gp-uk contributor (Dr Midgeley) suggested that the very prescribing
of an anti-dperessant soemhow was a part of the "investigation". His
response here was

"Trials of therapy are sensible, effective and safer than many other
investigations.  Modification of diagnosis or hypothesis inthe light of
response or lack of it to treatment is important."

So by definition, soem people will be given anti-deps even though it
turns out they were not depressed. That is all I have been saying all
along.

Is investigation by therapy sensible in this area when Prozac has been
seen to be so dangerous. If anyone is interested I have the study that
shows a higher incidence of suicide on Prozac than any other drug.

(Did anyone read last week-ends Sunday Times Supplement story on the
secret settlement by Lilly of some of the US cases. BTW for the
middle-agers amongst us  the current US case relates to the suicide  on
Prozac of sixties singer Del Shannon ("Runaway", "Hats Off To Larry"
etc)).

Comments on the papers:-

The 1994 BJGP is not a study on the issue but simply reflects the view
that there are "many" undiagnosed and concentrates on how to deal with
the problem.

Moon et al doesn't deal with under-diagnosis at all.

Sireling paper works totally against you. It is clear evidence that not
all patients treated as depressives are truly depressed. My very point.
QUOTES
   "About half the antidepressant treated patients
  received RDC diagnoses of major depression. Among the other treatment
  sample, only one-fifth met these criteria, and half had non-
  depressive diagnoses. Most cases of depression treated by GPs satisfy
  criteria for psychiatric disorder, but tend to be relatively mild and
  borderline in quality."

Therefore some are not depressed and  HALF  of those who were treated as
depressed but, fortunately,not given anti-deps  did not satisfy the
criteria. So GPs are wrongly diagnosing to a not insignificant degree.

MacDonald helps you even less!
"less than 12% of the disagreement between the research assessment of
depression and the general practitioner's assessment was due to "missed"
depression."

So over 88% must have been due to "missed" non-depression?

"There were, however, low rates of referral and of treatment with
 antidepressant drugs."

Note, not "low rates of diagnosis".

"If these findings are confirmed the study of
  the management and outcome of depression in such patients may be more
  rewarding than attempts to improve the recognition of depression."

Thank you, once again my point. This shows not such a large  problem
with under-diagnosis else why say less rewarding to attempt to improve
it.


The others are in support of the under-diagnosis but, as you say, only
in the US. Not relevant to the practice here. A further dsitinction is
that they are mainly pre-SSRIs. Diagnosis and treatment in the US
exploded with Prozac.


Graham

As to whether This all echoes the problems with the original trialling
of Prozac. I have been reading some of the Freedom of Information papers
from the FDA (I co-orinate all UK Prozac litigation) and public
testimony given in the US courts. This shows that Lilley told the
doctors undertaking field trials to not report any incidnets (suicidal
ideation/assaults etc) that they thought were due to the underlying
condition of the patients rather than to the drug.


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