Brian and I were discussing yesterday the high number of people we know currently on antidepressants. Much has been written about the rise in prescriptions for these meds, but I have to admit I haven’t really paid much attention. Obviously there are more and better meds available today than ever before, but are people more clinically depressed today than in the past? If there are, then here are some of the things that Brian and I speculated to be the most likely causes:
- Increasingly empty societal values (unhealthy body images, materialism, MTV)
- The erosion of religious fervor leading to a rise in existential crises
- Increased leisure time to contemplate 1 and 2
- Food additives, preservatives, pesticides, growth hormones, etc.
I’m leaving out purely neurochemical causes because I can’t believe that America in 2007 simply has greater numbers of purely neurochemically imbalanced individuals (people who, simply as a physiological or genetic fluke, have bad chemicals on the brain) than in, say, 1950. If we truly do, then #4 is the most likely culprit.
Whatever the cause, I’m still made very uneasy by the prescription of antidepressants to treat any of the four above causes.
Is the appearance of increased prevalence caused by an actual increase in the number of persons with the disease, or does something else account for your belief that more Americans are depressed?
Perhaps people who aren’t depressed are being misdiagnosed or provided with incorrect medication. The existence of a medication will tend to lead to it being prescribed.
Perhaps increased awareness of effective treatment options is causing people who previously didn’t seek treatment to seek treatment.
Maybe there’s less stigma associated to seeking treatment for mental illness nowadays.
And so on. Surely get the point. It’s important to examine your premises and consider alternate explanations; maybe you’re worked up over nothing.
Somehow I think that the answers are all of the above. More people are being prescribed antidepressants because there is less stigma, because many people are being misdiagnosed, and because more people are depressed either because of purely physiological factors or factors 1 through 4 above.
I have to say, though, that I can’t imagine the lessened-stigma/increased awareness numbers to be very large – undiagnosed depression would seem to me to be a quick route to suicide and yet teen suicide has risen sharply since 1950. More likely would be mis-diagnosis and over-diagnosis due to pharmaceutical company pressures and/or incentives. Which is hella scary in itself.
The thing I didn’t see on your list is the rise of transnational pharmaceutical companies. I think that profit prerogative is responsible for many, many prescriptions.
Colter, I don’t think it’s true that undiagnosed depression is a direct route to suicide. Depression is milder in some cases than others, and being depressed doesn’t necessarily imply being suicidal, or suicidal to the point of actually killing oneself.
As for points two and three and your assertion that teen suicide has risen sharply since 1950, can you offer statistical evidence? Do you have any evidence that religiosity has declined or (more importantly) that reduced religiosity causes depression? Do you have evidence that people have more free time? Sure, statistics can be manipulated, but I still think that they would bolster your argument. At present, you’re open to the criticism that you’re arguing by assertion.
This seems like an interesting conversation. Here are just a few comments:
SSRI such as Prozac, have fewer dietary restrictions than MAO inhibitors and fewer side effects than tricyclics. MAOi and TCAs were the mainstay antidepressants prior to the late 80s and early 90s. Thus, SSRIs could be perceived as more appealing than previously available antidepressants. A common argument for the increase in the number of scripts being prescribed is the increased pressures from HMOs to get individuals out of therapy and onto meds to manage Psychological illness. I would point you to the APA’S website for stats used to support this argument. The correlation between antidepressants and suicide is sketchy at best, with the amount of variance accounted for by medication being very little in large-scale statistical models used in outcome research. I would point you to the NIMH’s public clearinghouse for research on mental health for data on this. Like Heath, I would be more convinced by stats than ascertain. You seem to be using the availability heuristic to estimate the base rate probability for several phenomena and using them as the basis for your arguments.
Oh hell no I ain’t going to the NIMH’s public clearinghouse for research. Those are the people who make the talking rats from the cartoon. In my experience that’s just bad news.