Doctor of Philosophy
Faculty of Arts
Raven, Melissa, Depression and antidepressants in Australia and beyond - a critical public health analysis, Doctor of Philosophy thesis, Faculty of Arts, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3686
In Australia and most developed countries, depression has vaulted from an obscure affliction to a high-profile modern epidemic, accompanied by a significant escalation in antidepressant prescribing. A strong orthodoxy has developed that depression is common, serious, and treatable, and that the appropriate treatment is antidepressants. However, there are public health and social grounds for questioning this orthodox story. Vastly more people are being diagnosed with depression, and treated with antidepressants, now than several decades ago. Yet diagnosis of depression is subjective, and is based on highly criticised criteria. Furthermore, the evidence that underpins the orthodoxy is weak and biased, and this is compounded by biased interpretation and selective reporting, particularly in relation to clinical trials of antidepressants.
Two analytical approaches are used in this thesis. The first is critical analysis of the objective validity of specific claims and assumptions about depression and antidepressants, using a mixture of epidemiological analysis and critical appraisal skills from the evidence-based medicine field. The second approach is a broad analysis of strategies used by advocates of the orthodoxy. This includes an analysis of how claims about depression and antidepressants and related issues such as suicide are deployed in the depression arena, focusing on what claims have been made, by which players, in which contexts, for which reasons, and with what impact. Also analysed are pharmaceutical industry marketing strategies, and strategies used by other players such as psychiatrists and consumer organisations, all of which often utilise claims about depression and so on.
The orthodox story has been promoted by many players, including psychiatrists, pharmaceutical companies, marketing companies, health professional organisations, consumer organisations, governments and government agencies, and the media. These players interact in complex ways, based on overlapping and synergistic agendas.
Key players have strongly promoted the orthodox story, despite contrary evidence, systematically exaggerating the prevalence and severity of depression and the effectiveness and safety of antidepressants for both depression and suicide prevention. Pharmaceutical companies have played a key role in the establishment and maintenance of the orthodoxy, skilfully recruiting other players to their cause.
A detailed case-study analyses how key players, including prominent psychiatrists and consumer advocacy organisations and pharmaceutical companies, have succeeded in making depression a central focus of Australian mental health policy, fuelling the boom in antidepressant prescribing. Not only have antidepressants been remarkably successfully and profitably sold in Australia, but also depression has been reified and marketed as an all-purpose explanation for distress. As well as exposing many thousands of people to adverse effects of antidepressants, this has deflected attention from social determinants of well-being.