Medicated Americans

Scientific American Mind has a fantastic article on the endemic use of antidepressant drugs in the United States. It starts with some surprising statistics: 11 percent of American women and 5 percent of men are on antidepressants.

Serious clinical depression is devastating, and if ever you needed convincing that mental illness should be taken as seriously as physical illness, you only need to meet someone suffering in the depths of a mood disorder.

In contrast, the article notes that the modern concept of depression and the diagnostic criteria have been increasingly widened to cover states of low mood or disinterest that would previously have never been thought of as a medical problem.

It’s full of interesting snippets from the scientific literature to suggest the pervasive influence of this new broader ‘depression’ on society.

For example, a 2007 study found that 1 in 4 people treated for depression have recently experienced a major emotional setback, such as a marriage break-up, a job loss or a financial crisis – suggesting the emotional difficulties may be part of a normal reaction to a serious life event.

A 2006 study found that three-quarters of people prescribed antidepressants receive them for a non-licensed or ‘off label’ reason – for a purpose that there is no strong evidence for.

Furthermore:

If statistics serve, we know a number of things about the Medicated American. We know there is a very good chance she has no psychiatric diagnosis. A study of antidepressant use in private health insurance plans by the New England Research Institute found that 43 percent of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of the drug. We know she is probably female: twice as many psychiatric drugs are prescribed for women than for men, reported a 1991 study in the British Journal of Psychiatry. Remarkably, in 2002 more than one in three doctor’s office visits by women involved the prescription of an antidepressant, either for the writing of a new prescription or for the maintenance of an existing one, according to the ­Centers for Disease Control and Prevention.

This is not to dismiss the suffering of those who have less disabling mood problems – each of which can be a torment in itself.

The key question though, is should it be the responsibility of medicine to prevent these unpleasant mood states, and if so, is medication the answer?

Psychological therapies are known to be effective treatments when depression first occurs and better than drugs in preventing relapse, and for much mild – moderate depression increasing activity levels and light exercise can be strikingly effective.

For more serious cases, a combination of drugs and psychological treatment is the most effective treatment.

The boundaries of illness say as much about our society as they do about our medical advances because it is impossible to define illness without making a value judgement about what point normal variation becomes a pathology.

Depression and antidepressants and complicated because there are many interests – individual, professional, scientific and financial – all shaping how we detect and treat ‘it’.

Over these last few months it has become clear that medication is not as effective as the published evidence has led us to believe, and that we need to radically rethink how we understand mood problems and help those who suffer them.

While the SciAm article focuses on the US where the problem is most apparent, it is clear that this is an issue facing many countries in the West.

Link to SciAm article ‘The Medicated Americans’.

2 Comments

  1. Posted February 29, 2008 at 1:28 pm | Permalink

    A small point, Vaughan. Off-label does not equal lack of strong evidence. Citalopram, for example, is off-label for premature ejaculation, and there is pretty strong evidence for such a use (http://www.nature.com/ijir/journal/v14/n6/full/3900918a.html).
    Whether treatment for a condition is on or off-label depends on FDA approval. But “FDA-approved” and “science based” are not interchangeable – often companies simply don’t bother getting their medicine registered for more conditions, as it is too expensive.

  2. Posted February 29, 2008 at 2:54 pm | Permalink

    Hi Michael,
    Point taken. I think a better description would be that there is less strong evidence.
    I don’t know of any situation where enough evidence exists to fulfil FDA approval but the company has not bothered to apply, however, it’s still possible to have strong evidence without something being licensed as you mention.


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