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Is It Really Depression?

Many people, when they aren’t feeling right or are having trouble sleeping, go to the primary care or family medicine doctor. These doctors are on the front lines of dealing with a great many issues and I have immense respect for the work that they do. If you got a diagnosis of major depression from your primary care or family medicine doctor, particularly if you have not responded to the anti-depressants your doctor prescribed, you will want to know about this research study.

In Australia it was decided that it would be good for doctors to know more about depression so they could help their patients more effectively. Before designing the training program, they first did a study to assess what the general practitioners knew about depression and how they treated it. 2,500 general practitioners participated in this study, which is quite a lot.

The results of this study are rather shocking, although if you read the study itself the study authors try to put a good spin on it. The authors conclude “There is a need to improve GPs knowledge in diagnosing depression.” Are you starting to wonder now if your diagnosis of depression was accurate? We don’t have a comparable study examining how doctors in the United States make their diagnoses, so we can’t assume that it is identical here, but I think this study still raises cause for concern.

In this study, they asked doctors to list the symptoms they used to identify depression. The number one symptom listed? Insomnia. 86.6% of doctors in this study listed insomnia as a symptom used in the diagnosis of depression. In fact, depressed mood was a distant third on the list, with 54.4% of general practitioners listing this as a symptom their used in the diagnosis of major depression. Considering that major depression is classified as a mood disorder, this strikes me as kind of odd that depressed mood was so low on the list of symptoms listed.

Now, in fact, insomnia IS one of nine symptoms officially used to diagnose major depression. In order to qualify for a diagnosis of depression, a patient must meet multiple criteria, including the length of time they have had these symptoms and they must also have at least five of the nine symptoms. It is entirely possible to have depression and NOT have any problem sleeping. In fact, many people with depression sleep too much in an effort to escape the pain of the depression. (Hypersomnia, sleeping too much, is a symptom of depression). When researchers looked at the information these general practice doctors submitted, only 28% of doctors reported enough symptoms to qualify for the official diagnosis of depression. This indicates that many people are erroneously being treated for depression by their doctors when, in fact, they need treatment for insomnia.

This is an important finding. It can explain, for instance, why many people do not respond to anti-depressant medication. In fact, only 33% of people experience remission of their depression when placed on an anti-depressant. If you have insomnia but are being treated for depression, no wonder you aren’t getting better! And, on top of that, you are subjecting your body and brain to chemicals (anti-depressants) that aren’t even needed! Anti-depressants have a role and can save lives– I’m not against their use. But I’m against using them when they aren’t needed. If you have insomnia, you can resolve that quickly and without drugs through the treatment called CBT-I, which is cognitive-behavioral therapy for insomnia, a treatment I specialize in. I also specialize in treating depression.

If you DO have depression AND you have insomnia, then resolving your insomnia is very likely to help decrease your depression. It is very important if you have depression to make certain that you are not overlooking a sleep problem that is going untreated. If you think you might have insomnia that has been overlooked or you are ready to put your insomnia to bed, give me a call and let’s set up an appointment to examine your situation and put together a treatment plan just for you. Day, evening, and Saturday appointment times are available. (816) 226-4678.


Krupinski, J., & Tiller, J.W.G. (2001). The identification and treatment of depression by general practitioners. Australian and New Zealand Journal of Psychiatry, 35, 827-832.

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