Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
11 Sep

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.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. 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.

    Anon wrote on September 13th, 2009
    • There was a cancer treatment by Dr. Stanislaw Burzynski, called antineoplastons, about which you may or may not have heard. Of course, the medical community generally asserts his treatments to be unproven, but a certain accounting of the treatments, “The Burzynski Breakthrough,” by Thomas Elias, chronicles various success stories (as well as a few tragedies). Long story short, the FDA aggressively tried to put Burzynski in jail, apparently for 300 years, even though his success rates were better than that of traditional methods.

      He was also sued and prosecuted various times for various things, including fraud. Wikipedia’s article on the Burzynski Clinic is less than supportive. Could he have done all the bad things people said he did? Certainly. But is it also possible that Dr. Burzynski came up with the most promising treatment for cancer and the powers that be in Big Medicine (including the FDA) squelched it? Yes, it’s possible. I’m not suggesting that is definitely what happened, but the reality is that there is no money in a cure for cancer. There is money in prolonging a person’s life, all the while making it necessary that they stay on drugs to stay alive. Big Pharma companies can (and probably do) meet or exceed their quotas in this fashion while simultaneously appearing altruistic. I have no doubt that there are many people in the pharmaceutical industry who want to improve the lives or the people who take their medicines, but there are also those who stand to profit enormously from others’ illness.

      Why else would Big Pharma have so much power? And they truly do. They influenced Obamacare as much as the medical establishment in general. We are regularly inundated with their frequent, lengthy, and often misleading advertisements, which are not limited to TV, but can also be seen in magazines and online.

      But to emphasize the general mood of the comment board and the article itself, I didn’t read anything that stood out as being anti-Big Pharma, especially because Worker Bee seemed particularly careful to be sensitive to those who have a genuine need for medical intervention. That said, I think the general mood tends to be that people shouldn’t look for a quick fix; educating oneself and being dedicated to improving one’s health will often lead to a better result, even if it takes more time to get there. But some people need medicine (until we can get to the root of the problems – cancer, for example). We don’t have a cure for cancer yet, but have we been looking hard enough? We should learn from mistakes, but we become complacent with the status quo. It’s the same thing that happened with grains, and it’s why they are still the biggest section of the food pyramid.

      So to expand on the conventional wisdom idea, grains were found to have fiber and some nutrients, so they were touted as healthful. Along came the government, and the subsidy was introduced. Grains became relatively cheap, and the conventional wisdom ultimately evolved from a naivete that grains are a healthy food. Those proponents of grains didn’t understand that they also have antinutrients. After all, they are the seeds of plants, so they probably have a way to survive the gut of an animal.

      But even with this information, people still hold onto CV out of pure stubbornness, ignorance, stupidity, or any combination of the three. Rather, they grow up with certain information from which they cannot detach themselves. It has already become part of their identity. I always picture lemmings, blindly following the others until they meet their demise walking off a cliff. Interestingly, real lemmings don’t commit mass suicide, but have an intense biological urge to migrate. This is actually more illustrative of the problem than the silly idea that lemmings have an irresistible impulse to commit suicide. Rather, it is suggestive of a society filled with individuals who have an innate need to follow the crowd (though they paradoxically want to be individualistic).

      I suppose I shouldn’t have said “long story short” above. My point in all this is that I think the general consensus from those who have commented on this article is as follows. Medication can be a benefit to society but should not be abused or misused. The abuse and misuse is as much a tragedy as the disease/disorder itself, and is perhaps more tragic. People should educate themselves about how certain chemicals will interact with their bodies instead of watching a TV commercial and asking their doctors for a prescription, a request to which far too many physicians acquiesce, whatever the reason may be. They should take the time to do an inventory of their health, a serious discernment, before they engage in behavior for which they don’t fully appreciate the consequences. This country’s health is poor because education about health is poor, and this problem is compounded by the fact that many don’t take the time and effort to do what is really best for them.

      Joe wrote on September 17th, 2013
  2. 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

    Mark Tyrrell wrote on September 14th, 2009
    • Mark,

      The link you posted goes to The Depression Learning Path, a depression website in the UK. Exactly what part of the site or what page details the basic emotional needs to which you refer?


      Julie wrote on December 17th, 2013
  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 wrote on September 16th, 2009
  4. 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.

    William Calhoun wrote on September 24th, 2011
  5. I am 46 and I’ve been diagnosed with major depression for 1 1/2 years. I struggled for 2 years prior trying so many things on my own to figure out my issues. Finally I went to my GPrac, who threw some Lexapro and Xanax at me. Got worse so we switched to Cymbalta, which was helpful for a few months but it stopped working also.

    I finally found a great Physchiatrist who has helped me work through my med issues, I know take Pamelor, Xanax (as needed) and a dose of Concerta (I also was diagnosed w adult ADD)

    He is a raririty, a compassionate Psychitrist that listens and actually encourages me to email or call his cell if needed.

    He has helped me understand that meds alone are not optimal…so I do meds, a separate therapist for longer sessions, nutrition, exercise and honesty about my situation with hose around me. I’m not cured, but I’m better…I just believe that when expletive think a pill will make them better, they are in for a deeper drop in depression and disappointment. It may work for oe but meds alone actually made me worse considering not effectiveness of some and the hell of Cymbalta withdrawal I went through.

    David wrote on July 15th, 2012

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