1 Selective serotonin reuptake inhibitors (SSRI) – sales, withdrawal ...

It is pretty clear that the inclusion of unpublished data seems to diminish the effect (12, 13). Kahn et
al argue that treatment is effective for patients with severe depression but not for patients with mild
to moderate depression (14). Thus, there is no consensus with respect to efficacy, which is
expected, as so much has been left unpublished.
Peter Conrad has described medicalization as a process by which nonmedical problems become
defined and treated as medical problems (15). According to Conrad the increase in medicalization
could be explained not only by a medical colonisation of human life conditions but also a decreased
tolerance to symptoms, social movements and patient organisations advocating for medicalization,
pharmaceutical industry and disease mongering as a way to increase profit (15).
Joel Paris draws our attention to the problems of defining the boundaries of depression. “Depression
is so prevalent that it has sometimes been called “the common cold of psychiatry” (16). But a cold
should not be confused with pneumonia, even if both share some of the same pathological
mechanisms. And treating colds as if they were pneumonia (i.e. with antibiotics) is just as mistaken
as giving antidepressants to everyone whose mood is low” (16). But that is exactly the problem
with depression that the DSM and ICD definitions are built on criteria which are difficult to
distinguish from depressed feelings as a part of normal life. “It conflates normal unhappiness with
the mental paralysis of melancholia”. Paris also mentions the time criteria as a problem for overdiagnosing,
as two weeks is a short time scale and is not evidence based. The same goes for the
cutoff point of 5 out of 9 criteria that should be fulfilled for the diagnosis dependence. It is unclear
where the 5 came from and whether it is a valid cutoff (16).
This is supported by Kendler and Gardner in a study from 1998 in which they found “little
empirical support for the DSM-IV requirements for 2 week´ duration, five symptoms, or clinically
significant impairment (17). These results suggest that major depression may be a diagnostic
convention imposed on a continuum of depressive symptoms of varying severity and duration” (17).
Also Roger Mulder describes that the differences between normal mood fluctuations and clinical
depression are differences in degree but not kind (18). Diagnosing depression needs to move
beyond the obvious symptoms but include the subject and the context, according to Mulder.
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