As part of an ambitious new plan, New York City doctors are beginning to screen patients for depression, using a questionnaire that inventories mood and behavioral symptoms. Though the test will not be mandatory, health officials hope every doctor in the city hospital system will be using the screening within the next three years. They have the resources to make their goal a reality - urged by an expert panel in 2003 to expand national mental health screening, Congress allocated $20 billion to implement such state programs.
With such a change, the question is this: Is it really a big deal if, over the next few years, testing for depression becomes as commonplace as slapping a rubber band around your arm and checking for high blood pressure? According to some, it is. The Alliance for Human Research, a patient-advocacy group, is launching a campaign to halt the new use of mental health screening, claiming that increased testing will only yield a dangerous stigma for a whole new population of possibly misdiagnosed depressives. Furthermore, the Alliance is wary of what they feel will be a necessary byproduct of increased screening: the over-prescription of antidepressant medications.
Organizations such as the Alliance for Human Research are right to be cautious about the overuse of antidepressants, but their efforts are misguided. While recent studies propose a link between the use of some of the more common antidepressants such as Prozac and Zoloft and suicidal behavior in adolescents, other researchers contend that that link is tenuous. Clearly, no health official would want a healthy person to experience the negative side effects of taking unneeded medication. But this possibility should not dissuade any doctor from supporting a program that could benefit so many currently undiagnosed New Yorkers with mental health problems.
The truth is that depression is the most far-reaching and debilitating of mental disorders. It affects up to 16 percent of people living in the United States and costs the nation $44 billion a year in missed work and disability pay, more than any other physical illness - including heart disease. While the thought of any respected doctor campaigning against increased screenings for heart disease for fear of overdiagnosis seems absurd, a whole movement is now trying to halt mental health screenings on the same grounds.
Despite what some fear, increased depression screenings will not necessarily result in overdiagnosis. If a patient's completed questionnaire does show depressive mood or behavior, the doctor will not immediately diagnose and prescribe medication. Rather, like any other sound medical procedure, the patient will be recommended to undergo further testing before an official diagnosis can be made. Screening, then, is not a means for practicing imprecise medicine, but rather an invitation to more thorough care.
And more thorough care is necessary when depressed people so frequently remain undiagnosed. Many never receive a diagnosis because they do not recognize the symptoms of their depression. Overwhelming negative and pessimistic thoughts may be commonly recognized symptoms, but other lesser-known signs exist, including changes in appetite and sleep routine. Imagine how many people experience such symptoms, yet never seek help from mental health workers because they do not recognize these changes as indications of depression. Screenings will curtail this problem by making doctors aware of dangerous symptoms, even if patients are not.
In an essay published in this week's edition of the New York Times Magazine, Peter Kramer, Brown professor and author of "Listening to Prozac," reminds us that depression should not be romanticized. It is a legitimate disease. While Kramer's argument takes on those who romanticize depression - those who downplay its severity by calling it a "perspective" - his point is also relevant to professionals in the mental health industry who also downplay the disorder, though for a different reason. Simply because depression is a mental disorder and not a physical one, we should not dismiss it as less grave than other disabilities. It should not be culturally invisible - or ignorable, for that matter.
If the momentum to increase screening New Yorkers for depression is thwarted, thousands will be denied adequate mental health care and treatment for a debilitating disorder. Even worse, public opinion will continue to downplay the severe health effects of mental disorders instead of giving them the attention they deserve.
Joshua Lerner '07 listens to Prozac, but only on Sundays.
