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
for those with stories of adhd and crippling depression, i have been there myself, experimented with pharmaceuticles and therapy for years (i am only 26 but have been seriously depressed/agressive/hyperactive/manic/ocd/eating disorders/insane since birth lol!)
i have always been able to appreciate nature and find my sanity there, so after finding no help in western medicine i started my own research and experimentation with what i knew worked(hiking, spending time with nature, farming, playing in a LOT of dirt!) and also found an MD who specialises in adults with ADHD and uses more holistic approaches to health. he tested me for allergies and heavy metal poisoning. much to my suprise, i am allergic to almost every common food allergen and also have some elevated levels of heavy metals in my system. as soon as i changed my diet to exclude any allergens my brain totally cleared….honestly within weeks i saw improvement in my mental stability that i never dreamed of achieving. i do take some supplements(coq10, same e,5htp,gaba) but mostly focus on an organic raw diet(yes meat too), exercise and continue to spend a lot of time with nature. i think its also important for people who think they struggle with depression to understand that any unwelcome emotion is just frusteration and misplaced energy. our society and culture really represses a lot of our natural urges and rhythms and it is only normal to feel frusterated by this. it is best to be sure our energy is going to what our hearts and souls REALLY disire, regardless of how that fits into this world, and also to accept some of the limitations of being human and having flaws. i believe a lot of the cause of disease on our planet whether it mental or physical all have roots in the toxicity of our environment as well.
whew! loaded subject! this is a fantastic post, btw. i’m one of the chosen in that i do have to take my happy pill every morning. however, through lifestyle and nutrition (i exercise religiously, eat primal, sleep whenever i can, keep in close contact with my friends, and get regular touch…even if i have to pay for it in the form of massage (calm down)), and copious amounts of fish oil, i take the lowest possible dose. my family history is a smorgasbord of mental illness. i am not from here, however, and i was shocked when i moved here to see how many people were on anti-depressants.
i’ll never forget when i was working at a health food store and a woman came in for some information on anti-depressive herbs because she didn’t want to go pharmaceutical. i probed a little to find out what was going on and she said that she’s been depressed and her family is really pushing her to “get over it” and “cheer up”. i asked her what was depressing her. she said that she lost her son in the war. i asked her how long ago that was. to me, when you can’t get over a death or something, your brain becomes depleted of seratonin and other feel-good hormones. she answered three months. THREE MONTHS.
i think that that encapsulates a lot of what the problem is. here is this country, we’re fed a huge lie that things are supposed to be easy. that life is one big party. any emotion that makes us uncomfortable should be done away with as quickly as possible.
i told her that i wasn’t a doctor, but that she wasn’t depressed, she was in mourning and she had to let herself have several good cries.
lula, interesting about the chromium. it also regulates blood sugar.
and kelly, the DSM…what a book. it is interesting to me the trends in mental illness as far as what goes in that book and not. i really believe that mental illness is a cultural phenomenon that changes as we change. remember when homosexuality was in that book? or hysteria? i think it’s the same with depression.
i don’t really see depression as necessarily a disorder but more of a very loud signal that something is very, very wrong with the way we live.
I really wish I had the brain power to respond to this subject properly, but it’s just not happening tonight.
Great article, great topic. I’m happy to say I’ve never been on any medications, ever, and I remain anti-drug for every reason short of cancer. I firmly believe anything that’s wrong with our bodies can be fixed naturally. But that’s my opinion and that’s how I’ll choose to live my life.
I think our country’s pill problem is two sided. On one hand we have a country full of people not willing to deal with life and the problems that come with it. They’re a fast food, microwave nation that wants a quick fix. On the other hand we have doctors getting kick backs from big pharma, more than willing to dole out pills like they’re M&Ms. It’s a sticky, sticky situation.
That second point while there is some merit to it is deeply flawed. If you’re a doctor, and a patient comes to you with a checklist of the symptoms of depression how can you not treat? If you don’t treat and send them to therapy and the patient commits suicide you will be sued for malpractice. “But I didn’t think he/she really needed it,” is not a valid legal defense.
As for the lady with migraines who was put on an SSRI. It’s a very common use of SSRIs. 5-HT (serotonin) does many things in the brain beside make you happy. It also happens to be in the enteric nervous system which regulates gut motility among other things. In fact no one really knows what causes migraines to begin with. There are several existing theories. Why didn’t you do the research before you took your medication? Or ask your doctor about the side effects. Ask a pharmacist who probably knows more about the drug anyways.
Listen buddy, I already said in my post that I was young and stupid. And being 21 years of age, naive as well. And you know what, I don’t think it’s such a horrible thing to expect your doctors to be up front about these things! AND having migraines that put me in the ER 2 or 3 times a month…well, let’s just say that I was willing to try anything to help.
And that’s like telling people to do their research before they eat that box of whole grain. The powers that be lead you to believe that it’s good for you and who are you to think otherwise?
Thanks for being sensitive.
Seriously! Not to mention the fact that while you are (sometimes) told that sexual dysfunction is a possibility, NO ONE mentions that it can remain after discontinuing treatment! Most doctors don’t know that! It is their JOB to tell us the side effects, the possible negatives and positives. The fact that they don’t do it isn’t our fault!
And expecting someone to do research before taking a life-saving or pain-preventing treatment is ridiculous. If you are depressed and at risk of suicide, you don’t think to yourself “I better read about this before I take it”. No, you take it because it’s supposed to stop those feelings! And you add the fact that – again – it’s the doctor’s job to inform you, so we shouldn’t have to!
Lastly, the doctor is responsible for deciding the best treatment WITH the patient. Most doctors try to stuff pills down your throat, and never discuss the other options with you, since they don’t have enough time. Add the fact that they get kickbacks, and it takes a very honest doctor to ignore the potential money and give the patient options. And while they can get sued for not giving them pills, they can also be sued for giving them when they are not needed. What is best for the patient should be the biggest consideration, but it isn’t in today’s world.
I think it’s a combination of things: the influence/advertising of the pharmaceuticals is very strong; people do want a quick fix–one that doesn’t take their precious time away from sitting on the couch watching TV (and therapy can take years–I did it for 12); and the insurance companies cover prescriptions without batting an eye–rarely and barely paying for therapy. Sad, really. We’d hate for anyone to have insight and understanding about their lives. (And I’m in full agreement that prescriptions are essential for some folks.)
I’ve actually stopped taking prozac quite recently, 6 days ago in fact. I went through a bad time about a year ago with anxiety and OCD. The drugs worked after about 2 months and I have to be very thankful for that because I was a real mess and life was a struggle. At the start of this year, I made a real effort to cut the carbs and start eating a lot more fats. I cut alcohol down to 1 night a week and ever since then I’ve been getting a lot better.
I think alcohol plays a massive part of the problem. It’s an acceptable extravagence every so often in moderation but people abuse it – often because of the stresses of modern lifestyle, the 24/7 lifestyle.
That’s just my view. I think if people gave themselves a bit more down time to relax, exercised more and cut the crap like alcohol then things would be vastly different but it almost seems to late to change things as Big Pharma got a firm grip over the medical profession.
My current lifestyle is that I work 9-5, Monday-Friday. Outside of that I lift two days using a modified 5×5 routine, I sprint one day and do burpee themed interval workouts one day a week. The other three days I normally walk the dog for 45 mins at a relaxed pace.
Life is getting better and best of all is that I’ve finally got my girlfriend on a lower carb diet and she is feeling better in her life too. She’s leaner and isn’t craving chocalate.
Sorry this is disjointed!. I think my overall point is that the problems last year would not have happened had I been living the lifestyle I live now.
Andy
My doctor wrote me multiple prescriptions for antidepressants even though I told him I was not depressed. Well, we were both wrong. I was depressed, but I did not need the antidepressants. Six years ago I found out I have non-celiac gluten sensitivity. I stopped eating gluten and many symptoms that had bothered me for years started to disappear. My mood became much lighter and my energy level soared. I never realized how depressed I was because I had always felt that way. I could hardly believe how wonderful one should truly feel. I can only describe how I feel now as “music is in my brain”. If I get the tiniest amount of gluten, my mood drops and the brain fog returns for a few days.
If you want to check out some articles and abstracts on the effect gluten has on the nervous system, go to http://jccglutenfree.googlepages.com/
I certainly won’t say that gluten affects everyone, but do consider the possibility a gluten free lifestyle may help some.
bit o fasting, low carb ketosis inducing paleo diet
walking daily 40 mins
some kind of weight bearing exercise some times per week…tyres, gym, dead bodies, rock, prebbles, stones, churches..gravy !
a pharm grade fish oil of at least 1000mg of EPA and a proportional amount of DHA
the Oblig 10000iu of D3 if not in sunny climes
bit of mag from a citrate, malate or aspartate source
Jacobson muscle relaxation daily ..few mins at night similar in morn.Truly Edmund was a genius
Do all this and even a person with the most intense anxiety will i’ll wager heavily be assuaged to a serious degree.
Some of the above works well for crack addicts with HIV who live on sugar and starch so imagine a common variety anxious personage.
For the people who have suggested all sorts of “natural” treatments and therapy-based treatments, thank you. However, I can tell you that I’m someone who has “tried them all” and sometimes, they don’t work.
I’ve been consistent with my exercise for the past 25 years. I’ve been through therapy and CBT, and I’ve read way more on the subject than I care to admit. I’ve tried all of the supplements, the dietary changes, etc.
When I was diagnosed in 2004, I didn’t even have TV channels in my house, so no drug manufacturers were suggesting anything to me.
I live in a rural (quiet) setting, I’m outside year round, I have a very peaceful family life, and I have the normal job and money issues that go with living in the US these days. I’ve been married to a wonderful and supportive woman for 23 years.
I eat reasonably well, my life is not full of unreasonable stresses, I have a job that is difficult at times, but also fulfilling because I am helping other people with chronic diseases to get better care in their lives.
In other words, I think I’m the perfect candidate to be a happy, healthy, well-adjusted person. And yet, despite many attempts, without the small doses of a couple meds that I take daily, I find myself thinking of only the negative things in the world and my life and thinking that things would be better if I simply wasn’t here.
I appreciate all of the comments and thoughts here, and I agree with many of them. Our entire lifestyle is basically a recipe for one disease after another.
But, there are times when something isn’t right and if a medication truly fixes the problem, perhaps there really is an underlying disease rather than just something that can be fixed by lifestyle changes.
I think it’s interesting that many people in our society seem to have the solutions to problems, and yet the people with the solutions are not the same people who’ve dealt with the problems. I think that it’s easy to make the time to exercise, but I can’t honestly claim that it’s easy for everyone to do that.
It seems that it’s always the skinny people who say that fat people should just eat less, and the people who aren’t dealing with depression who “know” how to cure those who do.
I’m sure this sounds defensive, but I guess I end up feeling defensive. I’ve been in some very dark places in my life and I’ve seen the changes that medications can have for people in dark places. I wish I didn’t feel the need to take any meds, but no one here has suggested anything that I haven’t already tried as an alternative.
I think you were able to articulate your issues very well in your post. It is important that while certain things can help some people, only you know what’s going on in your body.
As an acupuncturist I often deal with chronic conditions. I think your ability to stand up for your body and your needs and remind people they haven’t walked in your shoes is admirable and deserves some acknowledgement. I wish many of my patient’s could stand up and learn from what you just did.
While there is a lot of misuse and overuse of medications in today’s world, there is a reason pharmaceuticals were manufactured in the first place. They worked when nothing else did. Additionally they often worked faster.
There is something to be said for living a life that is satisfying. That in and of itself can help with your overall health. We all need to make our OWN choices because owe are the only people who really know our bodies. I think THAT is a lesson everyone needs to learn and remember.
I have been on the rough rides of several bouts of Bipolar depression myself and has some history in the family as well. I have seen or heard mostly of the other extreme – where people refuse to admit that there is a problem. So one reason you see more people on meds could be because people are consulting docs for their problems that they would never have admitted earlier.
I have had a doc induce a manic and a subsequent depression(and a couple of deaths in the family during the time) because of overdoses of anti-depressants. I was on a supposedly life long medication, Lithium, which I have stopped since a while after getting my life in order – a regular exercise program, dumping all junk food and colas and choosing natural foods instead and walking away from two stressful jobs. Also my liver was impacted(but found early) due to side effects of some of the meds I was on. Right now, I guess I know the root causes of my problems and I think I have a handle on it. As many people point out here, it is the treating of the symptoms instead of the real causes the real problem here. But I believe this is a problem that can be treated without meds if the root cause is figured out and in my case nobody helped me find out for a long time till I figured it myself.
I think this post handled the issue sensitively and I appreciate that.
However, the complete Big Pharma bashing is uncalled for. Medicine–pharmaceuticals–saves peoples’ lives. My father’s life expectancy has doubled because of the drugs that were created, tested, and distributed by so-called Big Pharma. What drugs? Chemotherapy drugs. Not to mention steroids, anti-nausea medications, vitamins, and pain killers that allow him to continue working full time despite having an extremely painful and aggressive form of cancer.
Sure, there are problems in the system, but don’t forget that real good is done for society by a lot of the people who work for these companies. Researchers spend their lives trying to make things better for the rest of us. The business side mishandles things, especially things that are human and not financial, but the industry as a whole is getting too much flack on here.
I know the point of this post wasn’t that all pharmaceuticals are bad. I just wanted to inject a reminder that the pharmaceutical industry is not black-and-white. Like most other things in life, it is extremely complex. But I willingly accept the flaws in order to receive the benefits. (Well, that’s not entirely true, as I support a massive overhaul of the system, but for all intents, it’s how it plays out in my real life.)
One other thing, totally different from my initial point: GPs prescribing psychiatric medications can be dangerous. My partner has bipolar-1, and his GP put him on an SSRI. It nearly drove him into a manic episode. A psychiatrist would’ve known better.
The crazy thing is that antidepressants are little more effective than placebos in lifting the symptoms of depression about a third of people using placebos or antidepressants will notice some symptom reduction.
Added to the fact that there has been a ten fold increase in the incidence of depression over the last fifty years (because we are living differently)
There are basic emotional needs as well as the physical ones that Mark describes http://unk.com/t/3
Mark, I have read how white flour and sugar can lead to chromium depletion and how milk interferes with chromium absorption. Low levels of chromium, as you know, can be linked to depression.
I have struggled, and continue to do so, with “the blues” and anxiety throughout the ups and downs of life. I truly believe that most cases of depression can be overcome with a clean “paleo” diet and plenty of vitamin D.
Thanks for all your great information!
Brendon
All I know is what worked for me. I had a lifetime of the usual endless cycle “unhappiness — eat the wrong thing–gain weight–unhappiness–eat–etc.”. I was doing what most folks do to live in an artificial, cruel, polluted, chaotic, noisy, stressful world: I self-medicated. Overeating for me (as alcohol for some, sex for others, drugs for others) wasn’t the problem: IT WAS THE SOLUTION. It helped hold off and ease the emotional and mental pain. Most of us are already medicated, self-medicated and in most offered solutions to personal health problems, that is being ignored.
Talking about “exercise, eating right, self-discipline, willpower, love” is all irrelevant if our own bodies hormones and chemicals have us locked into a vicious cycle. Why do any of those things ? Why bother? Why care? If all we know is pain and hurting, pain and hurting which sneaks up on you subtly, slowly, carefully until you take it as “the way things are”.
Prozac broke that cycle. I’ve lost weight, changed my eating habits, my exercise habits, I have more energy, more life, more caring. Prozac gives me that boost, that little lifting of the darkness which allows me the foothold to begin changing everything.
Placebo ? Bad drugs? They work for me and have given me back my life.