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<\/a><\/p>\nBesides antidepressants, they’re talking about Cognitive Behavior Therapy. CBT is a legitimate and effective therapy, but it’s not generic. In my area, most mental health types would list it as their first line discipline. But I don’t think I’ve seen a full course of what Aaron Beck would call CBT in the eight years I’ve been involved. What happens in formal trials and what happens in the "natural world" are very different things. So I suspect that the majority of waiting room depression would be treated with medication.<\/p>\n
And then there’s the question of what constitutes depression<\/font><\/em>. Would it be people who say they’re depressed? – which is what unhappy people nowadays say to describe how they feel – bad marriages, no marriages, the burden of a difficult biography, personality disorders, situational crises, grief, lonliness, etc. The formal diagnosis of depression<\/font><\/em> has become corrupted in the recent era – simplified to mean almost any constellation of discrete symptoms and causes. So even discussing it as if it’s a unitary entity is hard to justify.<\/p>\nBut I don’t think those things are why depression screening evokes such a visceral "No" when I hear it. One part of that is the global burden of depression<\/font><\/em> meme that introduces so many articles on antidepressants [and blogs by our former NIMH Director for one] implying that through some not-so-clear-mechanism<\/font><\/em>, the incidence of depression-the-vaguely-biological-entity<\/font><\/em> is accelerating. It makes little sense. If there were a genetic or neural circuit etiology, why would it be increasing? And were that true, what does the symptomatic treatment with medications have to with that? Those arguments invariably precede a pitch for more funding for brain research or some new, innovative, treatment for depression, loosely based on a 2004 population study by the World Health Organization. And so this whole line of thinking seems flawed to me, a cascade of unproven and unexamined assumptions that have achieved an autonomous momentum that will only be amplified by waiting-room-depression-screening<\/font>.<\/p>\nAnd the other related visceral thing for me is that this way of thinking simplifies and reduces the infinite variance of human suffering. Depression is an expressive and communicative human emotion – obvious with little more that brief look. The idea that one can practice decent medicine and need a questionnaire to identify it and inquire about it says something about the system of practice envisioned by a world of people who don’t understand what "
practice decent medicine<\/font><\/em>" means. The PHQ-9 questions aren’t about subtle things:<\/div>\n <\/p>\n- Little interest or pleasure in doing things?<\/font><\/li>\n
- Feeling down, depressed, or hopeless?<\/font><\/li>\n
- Trouble falling or staying asleep, or sleeping too much?<\/font><\/li>\n
- Feeling tired or having little energy?<\/font><\/li>\n
- Poor appetite or overeating?<\/font><\/li>\n
- Feeling bad about yourself – or that you are a failure or have let yourself or your family down?<\/font><\/li>\n
- Trouble concentrating on things, such as reading the newspaper or watching television?<\/font><\/li>\n
- Moving or speaking so slowly that other people could have noticed?<\/font><\/li>\n
- Or being so fidgety or restless that you have been moving around a lot more than usual?<\/font><\/li>\n
- Thoughts that you would be better off dead, or of hurting yourself in some way?<\/font><\/li>\n
<\/sup><\/ul>\n
I’m aware that this second thing may say more about what I think of modern medicine with its emphasis on work product, cost containment, objectification, uniformity, and guidelines than it has to do with screening for depression. I just know that depressed people feel alone and unseen. I think if a doctor pointed at my PHQ-9 and said, "I see here that you’re depressed," I’d feel even more unseen. If on the other hand, she looked me in the eye and said "I can see that you’re really depressed" and asked "What’s going on?" I’d feel seen and maybe not so alone. Screening is generally designed to "pick up" things that don’t show – a pap smear, a blood count, a fasting blood glucose, an EKG, a serologic test for Syphilis, a questionnaire about past medical history or a review of systems. Depression shows. And I see screening for depression as interpersonal, part of the human interface.<\/div>\n","protected":false},"excerpt":{"rendered":"
I was sitting in the waiting room Friday morning waiting for an ENT appointment [to check a worrisome non-healing lesion in my nostril]. The big tv was looping through an animated description of some balloon thing they could do to your sinuses and a hearing aid spiel about why getting them from an ENT is […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-63356","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63356","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=63356"}],"version-history":[{"count":20,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63356\/revisions"}],"predecessor-version":[{"id":63399,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63356\/revisions\/63399"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=63356"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=63356"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=63356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}