Trends in depression and medication

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U.S. Antidepressant Use Doubled in A Decade. I’m not against the usage of medicine, but I’m skeptical that this increase is really attributable to chronically depressed people with serious neurochemical imbalances getting treated. Rather, a substantial number of people whose lives “suck” at a given moment convince doctors to prescribe these medications. I’m willing to be corrected by data on the usage patterns, but that’s just my limited personal experience with a range of people who get on these drugs in response to general suckiness, and the smaller number of people with modestly bizarre personality shifts makes me wonder as to more “modest” side effects which are not gossip-worthy.

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11 Comments

  1. I’m skeptical that this increase is really attributable to chronically depressed people with serious neurochemical imbalances getting treated. Since the “imbalances” are merely hypothetical, your skepticism is more apt than you probably realize. 
    makes me wonder as to more “modest” side effects which are not gossip-worthy. Well, they’re generally habit-forming in the sense that a physiological dependence develops.

  2. Isn’t it normal for people to buy products in an attempt to make their lives suck less? Unless you’re a Puritan, ascetic, or pharmacological Calvinist, I feel drugs should be bought and sold like any other consumer product that carries a risk to the consumer.

  3. Use of anti-depressants strikes me as similar to recreational drug use, but socially acceptable because of a doctor’s stamp of approval.

  4. I see absolutely no reason for suffering when a little pill takes it away. Is a sucky life worth suffering? Maybe not. If a sucky life can be make less sucky, why not? 
     
    Win win.

  5. If I weren’t taking Fluoxetine I would not be functioning at all. Seriously, not functioning at all. I would very likely be dead. I will not say that anti-depressants are not misapplied, but neither are they being misapplied in all cases. For some people antidepressants are necessary to alleviate mood and restore function. 
     
    Keep in mind that people differ in how they respond to medications, especially those that affect mood. For me Fluoxetine works well, for others it is contra-indicated. Some have no trouble with Paxil, I’m one of those who can’t have caffeine with that drug because they have a synergistic effect on my tendency to anxiety attacks. 
     
    The fact that people now receiving antidepressants don’t really need them does not mean that everybody now receiving antidepressants don’t need them. Some of us do. Being clinically depressed is not a matter of choice for everybody, and what we need for effective treatment is not always a matter to be dismissed with blithe talk and easy decisions.

  6. To begin with, I don’t want to take anything away from what Alan says. A significant number of people who previously would have been disabled and miserable have been helped enormously by drug treatment.  
     
    What I think happened is that these successes were extrapolated (by drug company advertising and also by school administrators, mental health counselors, public health workers, pyschologists, MDs, etc.) to apply to people who were simply unhappy or who felt unfulfilled. As far as I know, there was no resistance at any point, since it was win-win for all players (except perhaps the patient) — they collected fees, or their jobs were made easier.  
     
    America’s natural optimism makes people whose lives haven’t gone well feel that something is wrong, whereas more or less every other culture thinks that it is inevitable that many or most lives will go badly and just expect people to suck it up. 
     
    Likewise Americans tend to physicalize all problems and look for engineering solutions, while lacking self-awareness or the capacity to examine their own expectations and the contribution their own habitual behavior make to their problems. (My own opinion is that most people are too conventional in their needs, expect too much, and work too hard, though I doubt that many here will agree. And people want families while failing to budget enough time for them.) 
     
    Relevant: Placebos are getting more effective.

  7. My mother took antidepressants briefly after getting divorced from my father. But she stopped after a few weeks; she said she didn’t feel like herself. The people I’ve known who started taking antidepressants also have seemed different afterwards in a way that’s hard to pinpoint (beyond just being less depressed, of course).  
     
    I see absolutely no reason for suffering when a little pill takes it away. 
     
    What if it totally removed your capacity for empathy? If the German word ‘Mitleid’ (=sympathy), literally ‘with-suffering’, gives a description of what is going on, then removing your own capacity for negative feelings might well also make you unable to empathize with the suffering of others. Not to say that this is what’s going on, but I don’t think it’s as simple as you’re making it out to be.

  8. The issue is not ultimately whether antidepressants are being used properly; that’s proximate. The issue is whether people are misrepresenting what they are and what they do.

  9. This is a complex issue.  
     
    For one thing, according to the figures I have seen, the vast majority (maybe 80+%) of antidepressants (ADs) are prescribed by non-psychiatrists. With the advent of Prozac, which has very few significant or life-threatening side effects compared to the tricyclics like Elavil, it became a lot easier to prescribe an AD to anyone who complained of depression. 
     
    Depression is a symptom, not a disease per se, and it seems to be responsive to ADs a lot of the time. Whether or not this is placebo is up in the air as ADs are not that effective in general but are very helpful for severe depressions. 
     
    If you look at the studies (especially the ones that are not funded by Big Pharma) you will see that patients show a “significant” improvement maybe 60% of the time with each drug while placebo shows a 25-20% improvement. While these changes are statistically significant, they don’t usually represent a complete return to a normal mood, rather they show a change for the good on subjective scales like the HAM-D and the patient may end up still feeling depressed. 
     
    The increase in the usage of ADs therefore has two main causes: the newer ADs are a lot easier to take and continue taking (although there is still a significant dropout rate in studies), and the safety issues switched the primary prescribers to family doctors and away from psychiatrists. There are a lot more family doctors out there so the chances of your getting an AD when you complain of depression are a lot higher. 
     
    As to whether or not this is overprescribing, that is still up in the air, but I believe that it is.

  10. Mikeyes, 
     
    Got bad news for you. There is a disease called “Clinical Depression”. It has gone under other names, but the fallback seems to be “Clinical Depression” To the best of our knowledge the cause appears to be a deficiency in the neurochemical seratonin, and for many of us this shortage is normal; it’s how we are. 
     
    Normal sadness has a cause. Normal sadness will pass with time and a bit of encouragement from others. Clinical Depression does not pass, and encouragement can actually make matters worse. I am, to put this simply, naturally disposed to see the dark side of things, and to treat even positive developments as bad news. That is the way I am. 
     
    Before I can address your other points I first had to address your error concerning the validity of Clinical Depression as a disease.

  11. Way way way back when (late 70s, early 80s) I was prescribed Elavil (I think, I don’t remember exactly) because I was demoted (not fired) from manager to asst manager.  
     
    I took the drug for maybe a month, probably less. I was not depressed, I was angry because I felt this demotion was unfair. It was essentially done to prevent paying me the bonus I’d earned ($10,000) for saving the company money on electrical bills.  
     
    Where are the studies on anger vs depression?  
     
    Anyway, I continued to work for this company for several years (my salary was not reduced with my promotion, nor were my benefits). 
     
    I eventually quit several years later over a dispute of one day’s medical leave to accompany my son from the hospital to rehab.  
     
    It really was the proverbial straw that broke the camel’s back.  
     
    Twenty years later I find myself being prescribed antidepressants for pain. Though x-rays supposedly show undisputed signs of arthritis in my ankles and hips, antidepressants do more for that pain than NSAIDS.  
     
    Not only that, the antidepressants help with pain in my shoulders, back, neck, and wrists that have no discernable physiological basis.  
     
    For me, the payoff is feeling somewhat less alert and happy while taking the antidepressant vs. pain that leads me to using a cane. It’s preferring one kind of perky over another.

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