Monday, 20 August 2007

Should doctors recommend alternative medicine instead of pills?

In the Guardian today is a discussion of the danger of over-diagnosing clinical depression, setting the diagnostic threshold too low. The argument that clinical depression is defined as persistent depletion of serotonin in the brain and many people do not have this biochemical state of affairs in periods when they are down on life. Diagnosing pills to alleviate this biochemical condition can be more damaging. We need to note that this argued over-prescription of anti-depressants is a new phenomenon since:
As recently as the mid-90s, the majority of GPs were aggressively against prescribing antidepressants, many preferring instead to advocate taking up vigorous exercise, a new hobby or making significant life changes (career, job, home). Although I know people who were reduced to weeping and begging for help in doctor's offices because their GPs didn't like them saying "I know I'm depressed", the old-fashioned approach did for the most part filter out genuine cases of clinical depression from cases in which patients were simply having a transient and inherently human bad patch in life.
Anyway this is not happening now and is supported by a study published in the BMJ which says

Based on these findings, he argues that "feeling sad, blue or down in the dumps" is a natural part of the human experience and that doctors, over the past 30 years, have too generally stretched "formal definitions for defining clinical depression" so that everyday episodes of low mood are being "pathologised." His conclusion is that patients who turn up in doctor's offices in a temporary blue slump should not be automatically diagnosed as suffering from mild clinical depression.

OK so what is the solution?
And in a healthcare system woefully short of talk therapy options, patients who need therapy or perhaps alternative medicine, not medication, will take pills. And with the pills come risks.
We can accept that with pills comes risk but what has alternative medicine do with this? Nothing as far as I can see. This cannot be an argument for alternative medicine as there is no evidence that it clears depression. Studies have shown that roughly one third of people will recover from whatever form of therapy they do. This is the placebo against which statistically validated positive claims need to be made against. Why not instead go back to what doctors used to do in the 1990s? I know that when I feel down, the quickest way to get out of this is to go for a cycle ride for an hour. Good old exercise. Has everyone lost their common sense in the 21st century?