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Antidepressants Up, Therapy Down

Antidepressants, Depression

Here’s some depressing news: Antidepressant use in the US has nearly doubled since 1996, according to a study out of Columbia University and the University of Pennsylvania. The study found that over 10 percent of the US population aged six and up now takes an antidepressant. Of those on antidepressants, only 20 percent get additional help from psychotherapy of any sort. These figures represent a breathtaking change from 1996, when (a still hefty) 5.84 percent of the population took antidepressants but of those, 31 percent saw a therapist. In the years leading up to 1996, we see an even more dramatic spike, with antidepressant use almost tripling in the six previous years between 1988 and 1994.

While it’s amazing to think that at this point 27 million Americans — one out of every 10 men, women, and children — depend on pharmaceutical drugs to get through the day, it’s even more incredible to consider that the vast majority don’t get any additional help to address the underlying issues causing the depression. They don’t get support handling difficult emotions, they don’t learn how to handle grief, when to leave destructive situations or how to improve them and so on — benefits that psychotherapy conveys. And so, the painful situation or chemical or nutritional imbalance triggering depression remains intact, ensuring continued dependence on drugs in order to cope. It’s the psychological equivalent of taking blood pressure medication without addressing the dietary issues that cause hypertension in the first place.

As of now, antidepressants are the most commonly prescribed drugs in the US, at 118 million prescriptions a year. According to Dr. Kelley Posner of Columbia University Medical School and the New York Psychiatric Institute, 25 percent of all adults have at least one major depressive episode at some point in their lives. The World Health Organization (WHO) predicts that by 2020, depression will be the second leading cause of the global health burden. If they’re right, that means that there’s still room for more prescriptions. In fact, Dr. Posner thinks that lots of people who need the prescriptions don’t get them. “Fifty percent of African-Americans who have depression don’t seek treatment for it,” she said. “Not enough people are getting the treatment they need.”

More drugs! More drugs! Everyone needs more drugs.

Others, however, have a more skeptical view. For instance, Dr. Ronald Dworkin, author of the book Artificial Unhappiness, says, “Doctors are now medicating unhappiness. Too many people take drugs when they really need to be making changes in their lives.” His colleague, Dr. Robert Goodman, a New York internist, agrees. He says that it’s not medical need that’s driving the surge in antidepressant medications, but marketing to both doctors and consumers. “You put those two together and you get a lot of prescriptions for antidepressants,” he said. “It’s hard to believe that number of people are depressed, or that antidepressants are the answer.”

Party pooper! Just when I was convinced that everyone should be on antidepressants.

Then again, studies show that cases of clinical depression have been multiplying by enormous increments, doubling right along with antidepressant medications in the past decade. But are more people actually depressed than in the past, or is some other factor at play, driving up the numbers? Says Dr. Eric Caine, chair of the Department of Psychiatry at the University of Rochester, “People are not so embarrassed [as before]; they are more open to seeking help for depression.” Perhaps that explains it, and also explains the rising number of antidepressant prescriptions.

Or perhaps it works in reverse: the rising number of prescriptions means that doctors need to slap the “depressed” label on ever more patients in order to justify dispensing the meds. And in fact, there seems to be a pattern here. As the old saying goes, “To a hammer, everything looks like a nail.” And so we see ever more members of the medical community saying, “More drugs; more drugs!” Thankfully, though, there are a handful of dissenting voices that say, “Maybe not.”

If people and their doctors believe that antidepressants are the answer, they might do well to look at the facts. According to an article in the New England Journal of Medicine last year, the press on antidepressants hasn’t presented an accurate picture. Of the 74 antidepressant studies submitted to the FDA between 1987 and 2004, only 38 were “positive.” The remaining studies found that antidepressants, in fact, did nothing to relieve depression. Zip. Nada. Ultimately, even the positive studies tended to find that the drugs worked only for the most severely depressed patients.

As I’ve written before, the potential payoff from taking antidepressants certainly seems negligible for most (not all, but most) people, especially considering the risks. Those potential risks range from increased depression and suicide to weight gain, nausea, congenital defects, chest pain, insomnia, stroke, and so on. Thirty percent of those on antidepressants experience sexual dysfunction, and a recent report found the drugs blunt the ability to experience and express love.

Certainly, there are effective and safe alternatives. First, as Dr. Caine points out, “In mild to moderate depression, psychotherapy is as good as or better than medications.” As I reported last year magnets have been found more effective than medication for many depressed patients. I’ve also reported on numerous supplements and herbal approaches that can help. And of course, dietary and lifestyle changes can make an enormous difference in mental outlook — just getting off sugar and starting to exercise can work wonders.

That said, there’s little chance that antidepressant prescriptions will decline anytime soon: quite the reverse. At this point, current sales net $11 billion worldwide, with sales in the US comprising 71 percent of that figure. Think about that for a moment. If taken literally, that means that 71 percent of all the depressed people in the entire world live in the US. And don’t get me started on the “fact” that 80% of all children with ADD and ADHD seem to live here too. Certainly the pharmaceutical industry won’t let such juicy profits slide, and their task is eased by the fact that neither the masses nor the medical establishment want to accept that, by and large, the pills are just expensive placebos. There’s just too much appeal (and too much money) in the magic bullet solution.