Yesterday, in a brief article Anxiety vs. Depression at Psychology Today, psychiatrist Fredric Neuman tried to explain why psychiatrists often prescribe antidepressant medication even if the patient indicates that her main problem is anxiety or panic attacks rather than depression.
He states that major depression can often have not a kind of sad feeling as its predominant symptom, but rather anxiety. According to him, when there are also other well-known symptoms such as interrupted sleep, loss of appetite and loss of sexual interest, this specific combination of symptoms can be clear enough for the psychiatrist to diagnose a case as depression: even when the patient would label herself primarily as suffering from waves of anxiety, not from depression.
I suppose he may be right – but only, of course, in those cases where (a) this anxiety or panic does indeed come together with other main symptoms of depression, and (b) where this occurs not incidentally but frequently, throughout most days over an extended period.
Brief as it is, Neuman’s interesting article leaves several important questions unanswered. Here are the two questions that came to my mind immediately:
1. Many people experience anxiety or sudden panic attacks once in while or even frequently. By itself, this may not necessarily be abnormal or an indication of illness; it can for example be caused by actual worries, or by a temporarily overactive self-protection mechanism. Can we be sure that psychiatrists will not jump too easily to the conclusion that such anxiety indicates an underlying depression?
In other words, can we be sure that psychiatrists will not too easily prescribe antidepressant medication – with sometimes far-reaching and undesirable side effects – even in simple cases where in fact it might be better to just address this anxiety by itself?
2. Neuman does define “depression” but did not really define “anxiety”. So this raises the question what degree of anxiety a psychiatrist should consider bad enough to justify the prescription of antidepressant medication. I suppose this applies to anxiety that is so intense that the patient cannot function normally in daily life anymore. But will it also apply to intermittent feelings of anxiety that the patient merely finds unpleasant or disturbing? Where exactly do we draw the border line between serious anxiety and fairly “normal” anxiety?
In other words, can we be sure that psychiatrists will not too easily prescribe antidepressant medication even in simple cases where in fact it might be better to explain to the patient that sometimes anxiety (just like grief) is not a kind of aberration but a natural feeling that we should accept as one of the many facets of life?
Neuman is a qualified anxiety expert (at the Anxiety & Phobia Center of White Plains Hospital) so I hope he will soon give us a follow-up article with a little more of his views on anxiety in relation to depression.
• tip: In my own perhaps too simple view, the best short-term way to counter a frightening, paralyzing, irrational attack of anxiety is this.
Seek out someone else who at that moment can be more rational than you. Do not yet start a talk about possible causes of your anxiety: for this will often just not work in your present panicky state. Instead, together with this other person try to do something, some kind of simple distracting activity.
• footnote: At the bottom of Neuman’s Psychology Today article is also a link to his personal blog, but due to a typo it will send you to an error page. Here is a link that works.
Of course depression has always interested doctors – in fact, since the earliest times. In the 1st century AD, the prominent Greek physician 
But I digress. The real process of “illnifying” depression began much later, in the second half of the 19th century. It has accelerated significantly since about 1900. Gradually, pharmacists, psychiatrists and hospitals discovered that there was big business in treating common mental health problems – including depression.
The question that arises here is, haven’t we pushed the borders far enough by now? Aren’t we beginning to overdo it?
Maybe that’s where we should draw the border line between illness and non-illness again. And, resisting commercial impulses, stop further illnification.
So it looks like people are flocking to those test pages not to find out whether they feel somewhat depressed (they already know), but rather to find out if this depressed mood is Really Serious. They want to know if their problems deserve the Official Badge Of Serious Depression. They want such a test either to confirm “Yes indeed, we have to label you as an Official Case of Depression” or they want the test to tell them “Oh well, it’s not as bad as you thought, you don’t formally qualify”. Both outcomes are not only dubious, but will help you no further. Of course some test results may also scale you, say, 3 on a 1-to-5 depression scale. Would that help you in any way?
To be fair, I must say there are also depression tests of somewhat higher quality online: those may have over a 100 questions, and more often use not a simple list but a tree-pattern setup, meaning that your answer to one question determines what questions you will get next. But usually these more complex online tests will give you only an incomplete teaser-result for free, and you will have to pay for the actual outcome.
So far for the vapid shallowness of the whole thing: the entire list does little more than “measuring” and confirming what you already hoped, feared, felt, or knew. But there are many more problems here.
Such professional tests also take into account that there are different kinds with depression with very different symptoms. Guiding you along that variety of symptoms, for example using a tree-pattern setup like I mentioned before, they will in the end not just determine how depressive you are. Rather, they will – as a preliminary diagnosis – indicate what kind of depression you may be coping with.
These short online depression tests are incomplete, superficial and methodically totally inadequate. They will not tell you anything you didn’t in fact already feel or know. They will not help you any further. They may label you in a way that is not always correct or wise. And they may leave you with a false and unfounded feeling of certainty.
May 22, 1859 –
