The Age of Antidepressants?
Now that we’ve turned the page on August’s Primal Challenge, we’re digging into some of our “regular programming,” including news highlights. We like keeping a finger on what’s new and novel – and occasionally outrageous. This one definitely fits the latter. (Hint: Are you sitting?) A few weeks ago the Archives of General Psychiatry reported the following: “Antidepressants have recently become the most commonly prescribed class of medications in the United States.” Yikes, yowza, criminy, uff da! No foolin’, folks. According to the findings, “The rate of antidepressant treatment increased from 5.84% … in 1996 to 10.12% … in 2005.” Want hard numbers? Approximately 27 million people in the U.S., the report says, used antidepressants in 2005.
(To be fair, the IMS, a company that tracks health care industry growth and trends, reports slightly different results (PDF), but the general trajectory remains dramatic. And the growth has continued since 2005.)
But back to the point. The researchers examined estimates from Medical Expenditure Panel Surveys in 1996 and 2005 as well as individual interviews with 18,993 people in 1996 and 28,445 in 2005. Also among the trends found… The use of anti-psychotic medications (in addition to antidepressants) in those surveyed rose from 5.46% to 8.86%. Want more? Simultaneously, the use of psychotherapy in those treated with antidepressants significantly declined from 31.5% to 19.87%. Finally, the majority of those surveyed received their prescriptions from general health practitioners rather than psychiatrists.
First, let us say that we don’t have anything against the existence of these drugs or the use of these drugs for the treatment of serious mental health conditions. And we’re in no way judging or criticizing any particular individual’s use of these kinds of pharmaceutical treatments. What makes our jaws drop is the big picture of it all – the infinitesimally short time interval for dramatic growth, the shocking trajectory of increased use. What the hey happened in the last twelve years? Did an asteroid hit? Did we happen to miss some cataclysmic event that shook a large portion of American civilization? Hmmm…
Sure, the researchers suggest a number of potential factors behind these trends, including the de-stigmatization of mental health diagnoses and treatment. (We applaud this progress, and think it’s about time. Our commentary here isn’t at all directed at the treatment of serious, chronic mental health conditions for which these drugs were initially created and intended.) However – and it’s a big however, if this de-stigmatization doesn’t explain the literal doubling of prescriptions, it certainly doesn’t explain the move from psychological to pharmacological emphasis. Yes, there are more and very probably more effective medications out there, but there’s also an elephant in the living room. Hmmm…maybe he’s performing on the T.V. screen now.
We’ve railed on this point before, but this seemed like a fitting time to emphasize the issue again. What would these numbers look like if Big Pharma hadn’t been allowed to begin television advertising? How have these marketing suggestions impacted the way we think about “managing” our mental health? (That phrase still doesn’t sit well somehow….) How have they impacted our sense of mental health period? For those of us who live the ups and downs of life but don’t suffer from a serious mental health condition, do these commercials ever make us question our own emotional well-being? Our own relative happiness? The stream of consciousness can take on a life of its own. What am I supposed to feel like day to day anyway? Do I smile enough? Maybe I don’t laugh as much as other people. What could I feel like? What should I feel like? Is it “normal” to expect that a tenth of our society’s population shouldn’t emotionally function without pharmacological assistance?
And one more caveat here – for those who don’t suffer from a serious mental health condition… Let us say that we’re not trying to diminish the impact of temporary stress. Life these days, with its often uprooted nature and crazy pace, makes it difficult to deal with the normal but significant effects of anxieties, grief, etc. Certain episodes even, such as serious illness or the loss of a loved one, can leave us feeling like we live in a clouded existence. Pardon if we stray from science for a minute, but maybe part of the problem involves a cultural disconnect with the underbelly of the human condition (particularly when it comes to grief) and maybe even an unreasonable expectation of what life should feel like day to day. Again, the media feeds us a distorted means of comparison. Is eating chips really that exciting? Do other people lead completely spontaneous, exciting lives in which they throw together massive rooftop parties to dance, flirt and drink soda? Pardon me while I go throw in another load of laundry.
Let’s add this. We wouldn’t discourage people from trying to get a leg up when they can on their well-being as they navigate rough waters. But this endeavor seems to suggest and entail something different than even a few years ago. Eat well, sleep well, exercise often, supplement wisely, unwind regularly? Is this really pat advice? Call us old-fashioned, but we don’t think so. We obviously believe in maximizing health – all inclusive health (mental, physical, etc.). However, we think there’s a distinction to be made between the impact of naturally healthy measures and pharmaceutical treatments for those not subject to serious and chronic conditions.
What’s disturbing is the seemingly cavalier prescribing of strong drugs with life-altering, even dangerous side effects for the general public. (Again, most prescriptions the report said were most often given by general practitioners who likely don’t have the full picture of these drugs compared with their psychiatric colleagues.) The pharmacological trend – the increase in use, the raising the bar to increasingly include anti-psychotics – and the dramatic decrease in simultaneous personal counseling suggest a head-scratching conundrum. We see two stories: either doctors believe all these patients suffer from serious and chronic mental health disorders, or they don’t believe all of them do. If the first scenario is true, why aren’t they then referring patients to therapists? Are they counseling them on lifestyle means of supporting mental health and reducing stress? If the second is more accurate, why are they putting so many people on these drugs? And, more to the media point, how many people ask for these drugs outright? Either way, we think, it’s a depressing picture.
Tell us your thoughts on the findings in this study and your comments about our current mental health treatment model? Thanks for reading.
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Posted By: Worker Bee
Hi, my name is Jamie and I’m OCD. I find life is much easier on medication than not, sort of like the difference between chopping up an onion with a butter knife vs. using a cuisinart. Lazy? Perhaps. In my humble opinion, however, life is too short to spend it strung out with anxiety. Therapy does help, but generally studies indicate that medication and therapy together are the best route. I’m guessing most people aren’t in therapy because of the expense. Even reasonable state-sponsored insurance programs have a high copay for mental health appointments (mine are $45 per visit…a stark increase over my $10 supply per month of a generic anxiety med). Therapy alone is not as effective as medication alone. So, there you go. I think a lot of it boils down to that. I myself have been in regular therapy now for 3 years and feel good about where I am….but I also know I am the most “normal” when I am medicated. I can’t imagine how OBSESSIVE I’d get about the primal lifestyle if it weren’t for buspirone. lol
I feel most of our mental issues are United States culturally caused. People just do not have the tools to be happy eventhough happiness is what we seek.
Too much information, mental overlaod and peole cannot deal with it.
We have these long laundry lists of requirments and if all are not met we are angry or sad.
I am not religious nor is this book but if everyone read this book we’d all be better off. The tools are so simple and easy to apply.
Healing Anger: The Power of Patience from a Buddhist Perspective by The Dalai Lama
Rusty
If you care to expand, are you getting Exposure and Ritual Prevention (ERP) therapy for your OCD? That is probably the most effective non-pharmacological therapy and has a better long-term prognosis than drugs.
Great post Mark. I might need some anti-depressants after reading it though( in the form of steak). It just saddens me to see (and know) people who have a pharmaceutical fix for every emotion that they feel. It’s a vicious cycle of masking the real problem over and over again. I see it especially in college with young adults now…I guess all we can really do is make people aware and set an example.
Jamie, Thanks for your response. I have friends with OCD and understand that it’s a chronic condition that can seriously interfere with the daily process of living. As mentioned in the post, the point wasn’t to criticize every use of these medications or to disparage in any way any particular person’s use of them. Some people benefit greatly from them, and there are few if any measures that could offer the same basic relief. Our point with the post is the big picture itself – the sheer skyrocketing of these prescriptions in the context of the overall ballooning of medications. Pharmaceutical products have their place, but we fear they are too often seen as a panacea and too often used as a substitute for more comprehensive care and legitimate alternative/lifestyle treatment options. Again, thanks for your feedback. It’s important to look at all of the angles in any discussion, and your story helps fill in that picture.
My doctor put me on anti-depressants for my migraines. Migraines, can you believe it? I was younger, mid 20′s, didn’t think to question him. Well, it destroyed my libido and 4 years later, I am still not back to where I should be…not even close. Stranger yet, when I talked to my doctor about it, his reaction? Another anti-depressant. You see, Effexor causes decreased sex drive, but Welbutrin causes increased sex drive, so that should even me out…Never got that prescription filled and stopped taking Effexor that same day. Fast forward to the PB and my migraines are GONE, just like my sex drive. F@#$ers. (sorry).
AMEN! I was on antidepressants for chronic depression, which I am now not taking. It did help, and I’m glad I took them – but I have no libido whatsoever. I wonder if that is a common side effect? I’ll definitely be looking up that one, to see if there’s anything that might help….. But it does help to know that I’m not alone, as strange as that sounds.
I have often thought that a class action lawsuit should take place regarding this. My poor boyfriend has had to suffer the slings and arrows more than he deserves!
We are in trouble…
http://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction
Thanks for that info – I wonder if any of the herbs listed at the end would help? I’m thinking I’ll pick some up and give it a shot. My boyfriend and I both deserve better! I wonder if we complained loudly enough that there would be some sort of response?
Great points. The pharmaceutical companies are big business. They promote like big businesses and care nothing for their consumers, just like most big businesses. They like you if you continue to make them money. So if you continue to be addicted or need more prescriptions, they win. Too bad you lose. Right? You are a smart cookie for quitting while you were ahead.
Big Pharma paid for 90% of all continuing education for doctors last year, not to mention all the free lunches and marketing materials they gave to doctors as gifts. It’s pretty disgusting as an industry.
And, even worse, most of the things people are prescribed psych drugs for have no actual basis in fact. But I digress.
I have found chromium to work wonders for my mood swings. Everyone comments on how stable I’ve been the past few months.
Big pharm has only the bottom dollar in mind-horrible, horrible industry.
In 2005 I got really sick with what turned out to be a small intestinal bacterial overgrowth. I had to do all my own research to find out what was wrong with me because when young women present with stomach problems to the typical middle-aged male doctor, we’re often just told to relax, eat some more fiber and get some exercise. Never mind that I was newly wed and pretty happy, vegan at the time and so eating nothing but fiber, and already pretty active as I was trying to shed the pounds that my high carb diet kept on me. As I hopped from doc to doc trying to be taken seriously, I managed to get myself put on Klonapin, Wellbutrin and Lexapro because obviously no one needed to test me for SIBO because all these problems were in my head! It took me months to wean myself off the drugs, which only made it harder to get well and lose weight. I finally found a doctor willing to listen to me and run the proper tests and now I manage my condition my own way, with a low carb diet and antibiotics/probiotics. Considering all the research I’ve had to do over the years I feel incredibly enlightened and empowered over conventional wisdom, however, my experience has shown me that it is hard not to submit to the will of unenlightened medical professionals if enough of them tell you you’re crazy…
Angela,
Okay so it’s been a couple years since you wrote this post but I just now stumbled upon it and want you to know I think it’s a brilliant little piece of writing. It’s just too damn long of a story to tell, but I can really relate to a lot of what you said, especially with regard to having trouble being taken seriously(!), and also how eventually you can end up caving in to all the pressure, and find yourself on antidepressants. I’m so glad you found your own way…I’ve had to do the same thing myself. Still kind of a process, for sure.
Antidepressant use – especially SSRI’s – is out of control in our society. The good thing is that the primal blueprint lifestyle goes a long way towards eliminating the need for most people to be on them.
Check out this interview I conducted with Dr. Stephen Ilardi who is taking a “primal” approach to treating depression with his patients:
http://tiny.cc/0QD3i
It reinforces everything Mark talks about in the primal blueprint. And as far as Big Pharma goes, they’re just opportunists. People have to first get out of the “happiness in a pill” mindset and actually make lifestyle adjustments that might not show payoffs overnight.
But that’s an even tougher pill for many people to swallow…
Updated link for the Dr. Stephen Ilari interview:
http://tinyurl.com/2bzuosy
The problem, as I see it, really boils down to the doctors and their quick-draw prescription pads.
I approached a doctor 10 years back for my life-long serious anxiety attacks. When I met him I told him that I wanted to go a more natural route and address the cause rather than have the band-aid solution. I asked to be referred to a psychologist or similar and he went on to tell me how long the waiting list was. Quite frankly, it was only three months but he would still not provide me with a referral. Then, quite bluntly, the next word out of his mouth, “PAXIL”. So I proceeded to tell him that I don’t really think that I want to be on an anti-depressant for my occasional, but severy, anxiety attacks. I asked him how long I would have to take them and he responded, “For Life”.
I took the prescription but refused to have it filled.
Doctors are too quick to prescribe and instead of delving into, and helping, someone with a serious condition. No money in referrals I guess.
BTW…I’d rather spend $85 per shot with a therapist than piddle my money away on meds that are going to change the chemistry of my brain.
uff da? is worker bee from the midwest?
Mom500, Good eye there. Yes, I have Midwestern roots. Don’t you love the quirks of this country of ours? Thanks for the note.
i grew up in minnesota. now i live in the west and don’t hear “uff da” too often!
(interesting article, btw – i do think they should give you less anonymous pseudonyms than worker bee, though!)
Mark,
Hmm, is it too early to add depression to the list of ‘western diseases’?
Let’s take a look at pop/mainstream culture. Using your example of people hanging out on rooftops, flirting and drinking soda – look whats on the media these days. Everything on TV and internet ads is about glamour and image. Now, I am only 28, and can’t appreciate how much of this went on in the 70′s-90′s, but I think its absurd how mainstream culture is with image, and everyone else. I can’t even imagine what its like to grow up as a teenage girl these days.
Reality this, reality that? How about live in your own reality, and stop being concerned with everyone else. I feel like so many people lose sight of the big picture, and just concern themselves with how inferior they are to everyone else. People are getting “richer” – monetarily, yet we are losing out on the richness that is living life. That’s something to get depressed about.
I’m 27 and I totally agree with you… Each time is harder for kids to tell the diference between “having” and “being”…
Sorry if there’s any mispell…
Saludos de México!
Great post. Obviously there are people who need and benefit from the drugs in question as evidenced by comments above. However, I agree that tv advertising is a big problem. Too many people are willing to opt for the pill solution, taking the easiest route rather than sacrifice lifestyle in any way to cure their problems. Due to time constraints doctors are often obliged to take the easiest route to get the patient out of their office rather than discuss viable options. There are side effects with any medication. How do we often treat these??? Another pill. And so it goes. Lastly, don’t forget that metabolites of these pills in urine, or expired but real versions get flushed into our water systems and end up in drinking water. In other words most of us are on low dose therapy for all of our region’s ails.
I’ve been taking meds for ADHD (attention deficit side, not hyperactive) and depression for 5 years. For years, in retrospect, I tried to use alcohol to “solve” my problems. Finally, in 2004, I finished a really, really hard race, a goal of a lifetime. And I felt numb by what I’d accomplished. The numbness gradually turned into thoughts of suicide. It made no sense. I have a great family, a nice home, no unreasonable stresses, I’m a healthy athlete, my job is fine, but I suddenly didn’t want to be around any more.
When I told my wife I thought I needed help, I was afraid of what she’d think. But, she was relieved to know that I’d noticed what she and my kids had been noticing for a while. She supported me every step of the way.
It took some time, some different medication trials, and some therapy, but I hit a stable point. My life is great again. But, I’m convinced that I might be dead without the intervention I sought. Or, I would have drowned myself in alcohol.
My mother suffered badly from mental illness and was addicted to valium in the 70s. She was finally diagnosed properly in the 90s, but it was too late. By then, her depression had destroyed her health. Today, at 66, she’s mentally and physically gone, although the shell of her body lives on.
My son started to really struggle in school over the pasts 18 months. At one point this past spring, his mother and I were furious at a report card. We went for a run together to discuss it, rather than unloading on him, like I wanted to do. My wife said she thought he was depressed. Depression is common in my family. We gave my son the option of punishment (taking away the things he enjoys most in life) or seeing a counselor to discuss what he felt about school and life in general.
It took very little time to determine that he was suffering from depression. After a few months of playing around with a medication and its dosage level, a boy who disappeared a few years ago is back. He smiles, he laughs, and he enjoys life again. He is planning for his future. Six months ago, he was trying to figure a painless way to disappear from the planet.
I know that Mark emphasized that he’s not against the appropriate use of these meds. I’m very honest about my history, especially because I feel men feel stigmatized and “weak” if they need mental health help. If my openness and honesty helps someone else to seek the health they really need, any cost to me is well worth it.
I do think that people should see a mental health professional rather than a primary care doc. I have a psychiatrist who has worked with me and my primary care doc every step of the way. For a while, I also saw a therapist. My son has a pediatrician, a therapist, and a psychiatrist.
My son is now planning a future he didn’t think he had just a few months ago.
When help is needed, the need is real and it should be sought. Until naysayers have “walked a mile in my brain”, I’m not interested in their general opinions about the disease. And, while it may be overdiagnosed, I am positive that it’s a disease. If you don’t think so, I’d recommend you read Peter Kramer’s books on depression.
I did everything right – diet, supportive family, exercise, stress reduction techniques, and yet I found myself thinking of ways to kill myself.
DML
DML,
Thank you for sharing your important story so openly. This is exactly why pharmacology is an important part of modern treatments for mental disorders, along with counseling and other less biologically invasive treatments.
But the increase in real disorders (not the incorrectly diagnosed) raises the question of why the increase is occurring? One suggestion that Worker Bee was touching on was that our modern lifestyle–in particular diet–may be partly responsible for the increase in real mental disorders like depression and anxiety just like it’s implicated in the increase in other disorders like cancer, heart disease, and autoimmune disorders. Actually, ALL of these disorders (mental and physical) have a physiological basis (otherwise meds wouldn’t work beyond placebo effects). Of course these diseases have been around since the dawn of mankind, but their dramatic increase (proportion of society afflicted) in the past 100 years or so needs accounting for.
Hopefully we can have a dialog that is both respectful of real sufferers and that tries to reduce the incidence of these diseases in the future.
Watch him as he grows. I spent ages 14-19 in an adolescent, hormone induced haze! I’m pretty certain that if it were 20 years later, I’d have been on anti-depressants. Once I hit 19, I came out of the haze, and everything was fine. I don’t know why, but I think the rush of teenage hormones really does a number on some kids. I think once the rush was over, I went back to normal. Looking back, it really was like night and day. Being a teenager can be rough!
Thank you for this reply, DML!
I have struggled with depression and anxiety for about 20 years and have been medicated for about 16 of them. When I try to go off my meds I get suicidally depressed and so anxious that I cry myself to sleep at night. Mental health problems run in my family for generations. However, I have the most severe case since my great-grandmother. As good as I feel on the PB plan, I have to take my meds. If I don’t take them I get so ill that I start crafting up ways to end the pain.
And, no, I’m not some weirdo. I have a masters degree and am a successfull human being. My point is that some people really do have severe mental illness and need the medication. I’d undoubtedly be spending my life in an institution if it weren’t for my meds.
“Is eating chips really that exciting?”
Yes. Yes it is. One of the hardest things for me to give up (chips and salsa, that is, not potato chips or doritos or any of that crap). I used to be able to plow through the blue corn chips and salsa from Trader Joes in one sitting as a substitute for a proper dinner. You just wouldn’t want to be around me the rest of the evening. Ah, those were the days.
ditto on the tortilla chips and salsa. There really isn’t a substitute that works, either.
I agree with Mark’s article the meds are great when coupled with effective therapy and under the appropriate care/medical specialty…I speak from first hand experience having dealt w/ PTSD, it was a short term thing to help deal with the underlying issues that could be brought out more “gently” in therapy than the “flood gate” effect. As a Veteran, the meds can be of great use in treating our troops who are dealing with issues, with the caveat that they get the accompanying therapy and aren’t just given out by their primary with no further help…
SSRIs/SNRIs are serious meds designed to treat serious illnesses and should, in no way shape or form be as prescribed as widely or with as little regard to their power as they are today.
In 2004, I went to my GP because I was stressed out and having a hard time sleeping. I also smoked a pack a day, lived on pizza and hadn’t broken a sweat in years so I’m guessing treating my body like garbage so was not helping the situation. I went home with a prescription for an antidepressant. Four days later, I started having muscle spasms in my abdominals. I went back to my GP and she advised me to stay on the medication for a few more weeks to give them time to work. You see, she didn’t know enough to recognize that I was having something called an acute dystonic reaction (it’s rare, one per 1000). Long story short, I now have a movement disorder called generalized dystonia. This is an outcome that may be been avoided had my GP known enough to refer me to a neuro when I first presented symptoms instead of leaving me hanging for another six weeks while it spread to affect other voluntary muscle groups.
Anyhoo, it’s not exactly a sad story. Five years later, it’s mostly under control and has left me with a profound respect for being able to move if and when you can. Eating healthfully (I’m a paleo/primal hybrid), getting lots of rest on a regular sleep cycle and being active makes a huge difference as the happier my body is, the fewer issues I have with it. Heck, I’ve even been able to do CrossFit for the past year. Aside from the occasional day where I’m not safe to be flinging weights around, I’m more than able to hold my own in WODs.
This is very loaded for me. Mental health issues abound in my family and for several years I fought going to therapy because I didn’t want to admit that I had the “crazy” too. Finally, I started therapy. It helped some, but I still had further to go before I hit the bottom. In 2004 I had a period of a little more than a month where I couldn’t function. I was in law school and I had a job so I managed to drag myself to class and work, but I was in a haze. I didn’t do any homework (thankfully a very understanding professor let me turn my final project in late, but I had major catch-up to do for the other classes). I finally started taking an anti-depressant and a couple of weeks later it was like the fog lifted. And I realized I had been in the fog for several years.
The thing is, I don’t want to be a tied to a pill. I tried to decrease my medication by halving it a couple of months ago with noticeable negative mood changes (lethargy, lashing out at my husband, hopelessness). I don’t think these were psychosomatic because it didn’t occur to me until several days after a major meltdown that I had decreased my meds and maybe that was why I was feeling so awful.
I have looked into homeopathic options and was seeing a local psychiatrist who works with people to get them off of prescription meds and onto a homeopathic remedy and eventually onto nothing at all. However, I soon realized he was not covered under my insurance and it just cost too much to continue that treatment.
So I pop my anti-crazy pill (as me and my husband call it – you have to have a sense of humor) every morning and it helps me function.
On the flipside, I think pharmaceutical advertising can be a dangerous thing. People see an ad, think, That will fix me! and demand it from their primary care physician, who only has 10 minutes per patient. When I started on meds, I was in therapy and was monitored by someone with mental health medication expertise who regularly checked up with me to make sure I wasn’t experiencing side effects.
Also, I have seen so many regular, normal energetic kids who never go outside and play, but sit in front of the TV all day, transformed into catatonic zombies by ADHD meds.
I agree that we are an overmedicated society. Don’t even get me started on my fears of endocrine disruptors in the water supply. It’s a shame that we’ve swung this far to this side of the spectrum because I think the people who really do have issues and do use the medications correctly and responsibly may get lost in vast generalizations about overmedicating.
One of the challenges I see with the whole anti-depressant issue is doctors prescribe them with no exit plan (mulitple refills) or a plan for resolving the suppressed conscious or unconscious emotions which are at the core. The treatment of depression with drugs is once again treating the symptom, not the dis-ease. Anti-depressants can help to create a space of clarity (for a limited time before going completely numb) to dig deeper within oneself. Unfortunately most people either don’t, won’t or are caught up in unproductive traditional therapy. Luckily I have found a couple non-traditional forms of therapy that helped me to release the deep seeded anger and grief.
I also highly recommend the book:
What Happy People Know
by Dan Baker, PhD and Cameron Stauth
This is a great book that has helped me immensely.
I have been on anti-depressants since 1996 and have never had it cause me to feel “numb.” I’ve also had over a decade of therapy and am pretty well adjusted at this point. I think the depression is the disease.
having a successful career in high stakes poker should become much more lucrative and easy in the coming years. *rubbing chin thoughtfully*
Depression and ADD can be a sign of amino acid deficiencies (such as tyrosine and tryptophan). Check out Julie Ross’s book- the Mood Cure!
Tried, don’t work
Great post, and very relevant. This is my first time commenting on your blog, though not the first time reading. My husband is the “paleo nut” and blogger of the two of us, so I’m usually satisfied with letting him do all the researching/commenting
However, as a mental health professional (art therapist), I felt the need to speak my mind on this one…
I think there are many factors contributing to the US increase in antidepressant use and simultaneous decrease in psychotherapy, some of which are obvious and some of which are more subtle. First, I think the dates of this study are significant, as the “pre-test” date of 1996 happens to coincide with the release of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM, in all of its editions up to the current DSM-IV-TR (text revision), has been the mental health profession’s attempt to classify, describe, and organize psychological disorders. Suffice it to say that our descriptions and definitions of specific disorders, including depression, have changed drastically since the first edition came out in 1952. Even between the third and fourth editions, major changes were made, in large part due to increased research and a shift towards more evidence-based diagnoses. So, in the time between 1996 and 2005, there has been a drastic increase in research and a change in our understanding of the presentation and causes of many mental disorders. This, in combination with an increased social acceptance of mental health issues, has absolutely led to more people openly recognizing and seeking treatment for these issues.
That being said, it is my belief that this increasingly open forum has also led to the over-diagnosis of many disorders and a casual attitude towards treating any symptom, even if full criteria for diagnosis is not met. The United States is a fast-paced culture of instant gratification, and the mental health sphere is no exception. Medication is often easier and works faster than therapy, and so many people see this as a quick fix to their problems. Don’t get me wrong: I firmly believe that psychotropic medication is extremely helpful, and even necessary, for many people dealing with legitimate psychological disorders. I have seen many people’s lives drastically improve from medication, both as the sole treatment and in combination with therapy. However, when anyone with a headache who is having a bad day can go to their GP and get antidepressants, I think it’s safe to say that there is a problem. It seems that over the course of a century, our country has gone from one extreme to the other: instead of forcing mentally ill individuals into an institution for the rest of their lives, we liberally pass out pills to anyone who thinks to ask for them.
It seems that one of the current trends in psychology research is to find the best, most effective treatment for a particular disorder. Much research has been done on psychotherapy versus psychotropic medication, and results are very individualized depending on the disorder and the extent of the symptomatology. It would be foolish to argue that therapy can be more effective than medication for more serious disorders such as schizophrenia and borderline personality disorder, but the line becomes a little more blurred when talking about ADHD and depression. Medication and cognitive-behavioral psychotherapy are both about 50% effective in treating depression, and there is no clear advantage to combining both. So, when given the choice to take a pill or spend 1hr/wk with a therapist, with the same result expectation either way, many people often go with the option that will involve the least amount of personal investment. Especially when the cost of psychotherapy is taken into account, medication seems like a better choice.
Therapy involves time, emotional energy, and the willingness to commit to change, factors which many people either don’t have or are not willing to invest. What a lot of doctors don’t tell their patients about medication, however, is that following a prescription regimen usually involves these factors, too. In addition to being on the therapist’s side of the aisle, I have also experienced mental illness from the client’s side. I struggled with depression through most of my college years, and spent much time going through psychotherapy and taking antidepressants. I was able to commit to therapy, but unable to do so with the medication. While it provided that “quick fix,” it didn’t resolve any of my problems. In my case, I would start to feel better after a few weeks of religiously taking my medication, and would then decide that I didn’t need to be on them anymore and stop. Because antidepressants only work while you’re taking them, however, a few months later I would be seeking out another prescription. The side effects of the drugs are enough to make many people stop taking them, but even those who make it through these will often do what I did: decide that the medicine worked and stop taking it. A lot of people do this with psychotherapy, too. They feel better after a few sessions, or decide that the “side effects” of therapy are too much, and they stop going. For the majority of people, however, getting a new prescription is easier, faster, and cheaper than going back to therapy.
Sorry that was such a long post, and I don’t know if I added anything to the discussion, but this is a topic I definitely feel passionate about!
Thank you for saying so eloquently what I would have said far less eloquently.
People want the quick fix–in fact one frustration I have is that acupuncture can help with anxiety and depression (particularly the side effects like not sleeping etc). It’s hard to advertise that because I realized many of my patients really did need therapy but they didn’t want to do it–they also didn’t want to do acupuncture because it wasn’t a quick enough fix.
I’d also like to recommend the book Our Daily Meds for anyone interested in how pharmaceutical companies got these drugs so well marketed…
I had acupuncture for two years and it did nothing for my depression and anxiety.
I actually published my thesis on lifestyle factors that differ between current and pre-modern times, and their relationship to mental health. =) It was a pretty paleo paper. I guy named Steve Ilardi from the University of Kansas also does this work. My email address is christopherheath@my.unt.edu if you wanted to contact me, I’m happy to send along the thesis, and/or the published article (which is shorter).
Good stuff though. Martin Seligman said it best, (quote is approximated), “something about the modern lifestyle creates fertile grounds for depression” And I believe it was evolutionary psychologist Crawford who wrote, “we live in an environment that our ancestors would find strange and unnerving” =)
Chronic long-term depression is one of the symptoms of hypothyroidism (I know coz I’ve had both since I was a kid). One of my sisters, who I believe is hypo, has her OCD & other issues treated w/Paxil or some such drug when she should be on natural dessicated thyroid & follow the PB instead of her hi-carb vegetarian diet–which would produce much better results, I’m sure. Hypothyroidism is an underdiagnosed disease and it makes me wonder how many poor souls are just being given an anti-depressant when they should be treated for thyroid disease!
Excellent point! Many cases of “treatment resistant” depression resolve when thyroid is adequately treated, and often thyroid *should* be treated at numbers many doctors regard as normal (like TSH 0f 3 or 5, or subclinically low T3 or T4)
There are somewhere around 50 – 100 chemicals which work as or modify the effects of neurotransmitters, and many of them respond to problems with the endocrine system via the hypothalamic-pituitary axis.
My “depression” is endemic to one side of the family and is more related to hibernation than suicidality. I’ve been on and off various meds for years. Curiously (or not) discovering the blood glucose swinging from (mostly) nearly diabetic to nearly hypoglycemic several times a day and sitting on that has made a spectacular improvement to the depression and ADD, as has (probably) adding more Omega 3 and sat fats: maybe Vitamin D3 also.
IF this was placebo effect then how come different drugs have markedly different effects – and how come with a rational diet I am maintaining on 1/6 of my original dose? (I tried 1/12 of the dose but started slowing down again so it’s not entirely driven by the high/low BG and hyperinsulinemia but controlling that has had major knock-on effects)
There are such a bunch of physical as well as mental stressors in modern life, including but not limited to crap diets and overexposure to environmental toxins, that finding the cause and dealing effectively with it may be hard. In many cases drugs are necessary but like statins they are used to medicate away the effects of an inappropriate diet/lifestyle instead of being limited to those who genuinely need them, or in the case of SSRIs for hypothyroid to cover up the actual cause of the problem
a practical note from those who do suffer from anxiety and depression from time to time – check out the mood cure by julia ross. neurotransmitter supporting dietary supplements are available that basically supply your brain with raw materials to make the neurotransmitters it wants to. most people are out of balance upstairs as a result of modern diet and lifestyle.
one of the reasons to take fish oil…great for the brain and good synaptic function
Big Pharma advertising on TV should be banned! While I am not entirely opposed to “Better living through Pharmaceuticals” I hate Big Pharma’s ability to come into my home and try to convince me that there’s a pill for everything!! Followup research has shown that when they advertise a new drug, demand for it jumps considerably! Most Docs are too lazy to actually diagnose you and are happy to write a script for whatever you request (as long as it’s not narcotics!!) My mom gave me advice when I was much younger and I believe it has helped me avoid depression: “When things are going badly, understand that it is only a temporary situation and that things will get better. Conversely, don’t get too pumped up when everything’s going great, because undoubtly rain will fall again”. (or something like that) When things go badly and I feel sad (or depressed) I ask myself “What’s the worst thing that could happen?” My usual reply is “I could be dead!”. Whatever was bumming me out doesn’t look so bad then.
This is a philosophical issue, mostly. Altruism, collectivism, egalitarianism… they have all been on the rise over the last few generations. The original American conviction that the individual lives in a rational, predictable universe where his own mind and actions have efficacy, and where his own happiness is all that matters, has faded.
Instead, we are exhorted daily, from every corner of the culture, to take pride in things which aren’t genuine sources of pride. Sure, we’re still given some credit for being smart, healthy, virtuous, and successful – but ultimately a person’s worth in this culture is determined by his ability to sacrifice for others. “Others” doesn’t have to be anything in particular, just so long as it’s not you. Family members, coworkers, neighbors, community, the poor, country, humanity in general, animals, the environment – whatever.
The problem is, self-sacrifice is not a genuine, reliable, or consistently achievable ideal. People know that, but no one wants to admit it. It still makes it’s effects known though.
They too plainly see the personal corruption of altruism’s more vocal exponents (politicians, media types, local busy bodies), and they feel disgust. But, they also feel anxiety. Altruists seem to have a control over the existence they lack. They know that these people are simply more adept at playing the con game we all play – that they’re not really extraordinarily talented or virtuous – yet they are the ones who reap all the benefits. The average person, lacking a conceptual, philosophical understanding of all of this, is left with only his emotions to guide him. He thus spend his entire life fluctuating back and forth between feelings of resentment and impotence when he choses not to play along, and feelings of guilt and disilusionment when he does. It’s a perfect recipe for depression.
Something not really addressed here is what happened to me. I found myself in a depression one day, realizing that I didn’t have the energy or care to get off the couch to get stamps to pay my overdue electric bill. Realizing I had some kind of issue, I went to my doctor, who asked me a lot of questions, and told me she could refer me to a therapist, or write a Rx. As much as I would have loved to go see a shrink, my health insurance at the time didn’t cover therapist visits at all, but had a $10 co-pay for anti-depressants. Being that I was living in NYC and making about $10/hr., I knew I wouldn’t be able to afford a therapist, heck I could barely cover my rent, so I opted for the pills, desperate for any kind of help. Luckily for me, my employer switched insurance companies three months into my taking of anti-depressants, and I was suddenly covered for therapy visits. I was definitely feeling better, but knew the pills were just a stepping stone. I called around and found a great therapist who immediately told me to get off the pills. I spent a few years with her, and happily stopped seeing her a few years ago with actual coping skills anytime I start to feel that slide again. My Doc, my therapist and I were all appalled at the fact that someone like me was put into a position to feel like taking pills was my only option. I was lucky on how it all turned out, but I can’t help but think of all the people who are given no choice but to get on meds for their issues whether long or short term. Healthcare in this country should be taking better care of us all.
Humans have not genetically changed all that dramatically in the last 30 years, so why has depression/OCD/ADD/ADHD diagnosis experienced such an increase?
My own anecdote: When I “came out” as depressed to my regular doctor, she immediately offered to prescribe me anti-depressants after speaking with me for five minutes. Is that really a long enough time to make a decision about chemically altering my brain? Then she sent me to a psychiatric nurse who again, just wanted to give me drugs and told me about all the various drugs even though I told her I wasn’t interested in taking drugs to help my depression. I didn’t want to just cover up my symptoms, I wanted to get to the root of my problem and chop it off.
I had to go back to my normal doctor after that, get her to push drugs on me again (sigh) and after that finally get a referral for a psychologist who helped me find my roots and we’re working on those now.
But that doesn’t stop my doctor from still trying to push anti-depressants on me even when I come in for a mundane non-mental health related problem.
I don’t understand the prescribing of anti-depressants or other such meds without some kind of check of brain function. Most doctors wouldn’t prescribe a statin without seeing a number, why mess with the brain like that? “Oh you feel better on it so obviously you needed it” doesn’t fly with me.
It’s all about money, the kick backs Dr’s get for pushing one drug or another in an effort to boost Big Pharma’s bottom line.
We need some love in this country.