Shouldn’t you find out if you’re suffering from depression?

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Concerns with overscreening for depression centre on whether healthy people are being misdiagnosed with – and then treated with medication for – clinical depression. There is a disturbing trend toward widespread screening of young people for depression in schools in both the U.S. and Canada, although sex- and gender-based analysis of this trend seems limited. The danger of this screening, critics argue, is that students may be inappropriately sent to psychiatric care and prescribed medication when their problem may not be depression, but possible histories of trauma, problems at home, or other issues.

Postpartum depression (PPD) screening poses similar concerns: The standard screening test for PPD - the Edinburgh Postnatal Depression Scale (EPDS) – has been criticized for a high false positive diagnosis rate of 30 - 70%. The concern, again, is that this can lead to unnecessary and inappropriate drug treatment for postpartum women who may instead need more family support, more income, etc.

No Benefit, Possible Harm from Routine Depression Screening
By Fran Lowry, Medscape Today, 2011
Discusses a study that finds routine screening for depression in primary care, as recommended by organizations in the United States and Canada, has not been shown to be beneficial, and may result in unnecessary treatment. (Sign-up is needed to view article but it is free.)

Mental Health and Pregnancy: An Exploration of Issues Regarding the Use of Prescription Medications
By Focus Consultants, Anne Rochon Ford, Lejla Halilovich, Azar Mehrabadi, and Barbara Mintzes, 2010
A summary of findings from a project conducted by Women and Health Protection discussing the main outcome of over-screening: over-prescribing, and the problems associated with anti-depressant use in pregnancy.

Postpartum Depression: Focus on Screening
By Lee S. Cohen, M.D., ObGyn News, March 2010
Comments on studies from Britain that question the value of the EPDS, and asks whether this applies equally well to the American health system. Calls for more research into best means of diagnosing postpartum depression.

A Systematic Review of Studies Validating the Edinburgh Postnatal Depression Scale in Antepartum and Postpartum Women
By J. Gibson, K. McKenzie-McHarg, J. Shakespeare, J. Price, R. Gray, Acta Psychiatra Scandinavica, May 2009. 119(5): pp. 50-64
Finds the Edinburgh Postnatal Depression Scale (EPDS) may not be an equally valid screening tool across all settings and contexts.

Am I Normal?
By Vivienne Parry, BBC Radio, 2008
Journalist Vivienne Parry investigates postnatal depression. More women than ever are being diagnosed with the condition; so does motherhood make women miserable or are we turning a normal, if difficult, psychological transition into an illness?

The Marketization of Depression: Prescribing SSRI Antidepressants to Women
By Janet Currie, Women and Health Protection, 2005
Maintains that many “simplistic screening tools” to diagnose depression, particularly in women, are being created by drug companies who stand to gain, through sales of antidepressants, from higher rates of depression diagnoses.

Postnatal Depression and Screening: Too Broad a Sweep?
By Margaret Oates, British Journal of General Practice, 2003. 53(493): pp. 596-597
A critique of the Edinburgh Postnatal Depression Scale, the primary test used to screen women for postnatal depression. There is a high risk of misdiagnosing women with this test - and the false positives (30-70%) could lead to unnecessary and inappropriate treatment

Postpartum Depression: Literature Review of Risk Factors and Interventions
By Donna E. Stewart, Phil Robertson, Cindy-Lee Dennis, Sherry L. Grace, Tamara Wallington, Toronto Public Health, 2003
Argues that problems with existing screening tools for postpartum depression make it difficult to recommend them for routine screening. Concludes that depression screening “must be combined with systemic paths for referral of cases and well defined and implemented care plans to achieve outcome benefits.”

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