Is a Glut of Antidepressants Really So Bad?The other week I read in the New York Times about a “glut of antidepressants.” The story was about the loose (and perhaps over-diagnosis) of depression in a community sample of over 5,600 patients.

Most of those patients examined who supposedly had clinical depression turned out to, in fact, not have it — only just over 38 percent met the official criteria after 12 months.

Somehow this got convoluted with the increase in antidepressants over the past two decades. “One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.”

While we can lament this increase all we want, I also can’t help but say, “So what?”

17 Comments to
Is a Glut of Antidepressants Really So Bad?

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  1. But if the issue was about the excess prescribing of antibiotics and then there were more medication resistant strains of bacteria,…,oh, that is already happening. Well, what if there were excessive prescribing of statin drugs for treating hypercholesterolemia and then people starting having unusual reactions like musculoskeletal problems, oh, again that is happening too.

    Well, there is a trend here. Claim there is a class of drug that has little to no consequences and then prescribe up the whazoo until, voila, consequences then occur. But, we have to wait to report them until patents run out so companies can gross 20 or so billion dollars on the run their drug(s) had.

    Hey, many of you have no issue with a business model running health care. Gee, wait ’til you see what a political/bureaucratic model will do with PPACA. Bet ya won’t be getting many brand name drugs then, eh?!

    Google “drug authorizations and consequences” and have a nice time reviewing all those happy links!

    • We have two decades’ worth of prescribing data on the most commonly-prescribed antidepressants. Other than the research showing they are generally far less effective than we originally thought, where’s the overwhelming evidence showing they are worse than the over-use of other drugs (such as caffeine, alcohol, etc.)?

      Do we read articles in mainstream journalism about the “overprescription” of insulin for diabetics? It’s just weird.

      John

      PS – A reminder to potential commenters — we don’t allow ad hominem attacks here, so if your comment contains such an attack, it won’t be published. Stick to the issues raised in the article, not the author.

      PPS – While Psych Central does indeed get some of its revenue from pharmaceutical companies, it’s never affected our editorial coverage, opinion, or reporting on drugs and pharmaceutical companies. This blog is littered with past articles I’ve written highly critical of the business and marketing practices of virtually every pharmaceutical company. You might find it beneficial to use Google search before making unfounded allegations. (Oh, and yes, we get some revenue from Google too!)

  2. I’m so glad to read Dr. Grohol’s comments. I also read the New York Times article and was very troubled by the whole tone of the piece.

    Why do I read so many media pieces about the use of antidepressants which invariably judge the medications and thus subtly pass judgement on the people who take them? The people who write these articles transition from statistics to their own biased analyses very quickly. Who gets to say how much is too much? Journalists, I guess.

    I mentioned my unease about this article to my husband and he said, “We should spend more time analyzing why our society makes it members so miserable that they turn to medication to survive.”

    I think he has a point.

  3. Not that I’m a big fan of meds, but to be fair, one fact that gets glossed over in reviews of this study is that if only 38% of patents qualify as clinically depressed 12 months after getting diagnosed and apparently being prescribed meds, this low percentage could reflect the fact that the meds are actually working, and as a result, many folks are indeed no longer feeling depressed.

    In other words, if the meds were 100% effective, then 0% of the subjects would qualify as depressed at the end of 12 months…but should that properly be seen as a sign that they had all been misdiagnosed ?

    In studies like these, I regret that researchers never seem to include a question which simply asks the subjects themselves if they feel better as a result of taking these meds.

    I know that researchers seem to have a built-in aversion to “self report” type questions, but actually asking the subjects for their opinions, though “unscientific” can sometimes shed an interesting light on statistics like these.

  4. Surprise, surprise! Dr. Grohol is a Founding Member of the Society For Participatory Medicine.

    There are so many holes in this Doctor’s case for the use of anti-depressants that I lost count by the time I had finished reading the article.

    First: the nonchalant way in which he states that primary care doctors are doing right by their patients who complain of depression, when they prescribe anti-depressants on the off chance that it could help. Really? No other criteria?

    To compare caffeine to anti-depressants is so far off the mark that I am left speechless by the comparison….made by a DOCTOR. Alcohol?…some validity with that comparison. But insulin? Is it not common knowledge that insulin is absolutely necessary in the control of diabetes? In any case, back to caffeine: the NY Times recently ran not one, but several articles debating the effects on one’s health.

    I took anti-depressants for years, one kind after another, until I can no longer remember the names of all of them. But the last one, Cymbalta, I took for quite some time. As a non-medical person with experience with anti-depressants, let me tell you about some of the side-effects of such medications: They include weight gain (with some brands), light or fuzzy-headedness, sluggishness, constipation,and then the little one that is rarely worried about: DRY MOUTH. Now this one is/can be of great concern for patients taking these medications. Dry Mouth leads to a number of dental issues, some that are a major hit on one’s pocketbook, to say nothing of pain. IF, as in my case, the patient has dental bridges, decay can start in the teeth upon which the bridge is anchored. Is it noticable? Not at all. Even in routine Xrays taken at routine check-ups with your dentist. NO….not until the anchor tooth/teeth are almost beyond repair does the person feel pain, signaling the problem. And money? Oh, here’s where it gets really painful. To replace a bridge these days costs in the thousands….yes thousands! Dental work is not cheap. I am paying off a loan for the first of two bridges that needed replacement. When I will be able to schedule the second one is anyone’s guess. I am retired, living on a pension, so….no dental insurance and no extra funds for these very costly procedures.

    Finally, the good doctor does not mention the fact that all of these anti-depressants are habit forming. One must lower the dose a little at a time to get off of them. That’s what I did. And guess what. I now feel better than I ever did while I was taking them. A certain amount of depression might be expected in our current upside-down world. But to go with anti-depressants as a first choice for help is, in my opinion, not a decision to be made lightly.

    • Thanks, I hope more people check out the Society for Participatory Medicine here:

      http://participatorymedicine.org/

      whose mission it is to help patients and doctors become equal partners in the health care (and mental health care) arena. (Not sure what this has to do with this article, but thanks for the chance to promote the organization!)

      Yes, I did indeed compare antidepressants to other common things — like alcohol and caffeine — we rely on the intake of to function in society. Because it demonstrates how, as a society, we’re perfectly fine relying on different substances to get us through our day. I think any argument that points out that caffeine is a “natural” substance while antidepressants are not is a strawman (since there are plenty of substances that are “natural” and will happily kill if you keep ingesting over time; and many others that have been made arbitrarily illegal).

      If antidepressants don’t work for you, don’t take them.

      But I’m tired of seeing articles suggesting that people who do take them and feel they are beneficial in their lives are somehow lesser people. Or that there’s something wrong with them. That’s plain old prejudice and stigma raring its ugly head again, because you’ll never find an article written like this about diabetics and insulin (or cancer patients and chemo drugs).

      And yes, like caffeine, alcohol, and every other drug on the market — both generic and brand — antidepressants have side effects. And their withdrawal side effects for some brands can be particularly nasty. But that’s not a reason not to take them; that’s a reason to carefully and slowly discontinue in partnership with your doctor (which I hope is a psychiatrist!).

      • My argument with your article was not whether anti-depressants were, in fact, reasonable treatment for depression. It was that you were comparing caffiene and insulin to these drugs. That was an apples to oranges comparison, in my opinion.

        In no way do I disagree that society often “labels” people with depression or other emotional difficulties and that this is very unfortunate. Psychiatric drugs can often be the answer to
        helping people cope.

        But the title of your article, “Is A Glut Of Anti-Depressants Really So Bad?”….the answer to that is a resounding “YES” when they are so readily available from primary care physicians who seem to prescribe them as a quick fix…..and who do not give the patient ALL the information as to dangerous side effects.

        Why go to a psychiatrist, as you suggest, when any physician these days can and WILL, with the flick of a pen, readily write a prescription for such a drug? That is the problem.

      • After re-reading your article several times I understand your point, and if these medications work for people, great, then they shouldn’t feel bad. If they help a person and they can tolerate the side effects then good for them.
        But lets say a person walks into a doctor’s or mental health professional’s office and states that they are feeling depressed and they have a few drinks every night and that it helps them cope and they could tolerate the side effects, then what, everything is still OK? Or someone has low energy and they treat this by drinking coffee all day and it gets them through and they can tolerate it, everything is good? That doctor is going to be OK with that?
        My bet is that a lot of doctors would tell a patient that this isn’t good. Hopefully you have a doctor who will perform a good physical examine and try to find out what the issues are. If they can’t find any physical issue then out comes the prescription pad.
        No, a person shouldn’t feel bad if these anti-depressants help them, but then why not take the stance that they are as much of a crutch as alcohol and caffeine?

  5. Umm, not clear to what your reply alluded to, Dr Grohol. If it is directed to comments by me with another author’s post a month ago, shouldn’t an email to me then made the point I was read as inappropriate?

    Anyway, overprescribing is an issue irregardless of medication class. We live in a quick fix, minimal frustration tolerance society, thanks in sizeable part to this media access. Careful what ya wish for, Dr G.

  6. My case. I came to the doctor, and said I’m depressed. He didn’t even ASKED me for the symtopms. No. He just prescribed me Cipralex.

    Ah, yeah. Just treat everything with pills.

    Who cares about cognitive therapy, psychoanalysis, etc.

    Probably 50% of the people being prescribed pills could be treated with cognitive therapy, but hey, then you have to WORK with this people, right …

    Just put them on pills. And majority will have to CHANGE pills, or CHANGE doses, or GO TRU horible withdrawals. But who cares, right?

  7. What about long-term brain changes that follow SSRI use- down-regulation of receptors and so on- that make us more vulnerable to recurring depression? See http://www.huffingtonpost.com/dr-peter-breggin/antidepressants-long-term-depression_b_1077185.html or similar articles.

    • Breggin, an anti-psychiatry advocate, is perhaps not the most unbiased voice to listen to in this kind of discussion. But his references are to mouse studies (done in the 1980s) and his own book (which, since I don’t own, I can’t evaluate, but a book isn’t the same as peer-reviewed journal articles by any means).

      The argument that something you take may be causing some sort of brain changes over the long-term is not a very persuasive reason to not take it to help a life-threatening concern in the short-term. After all, everything you intake causes long-term consequences to your body and brain. Alcohol. Caffeine. Antidepressants. Antipsychotics. Aspirin. Chemo. Etc.

      But all I say, let’s not single out antidepressants as the boogeyman.

  8. Yes.

    It’s a waste of money. It offers potential for long-term harm. Comparing drugs that are legal because prohibition is ineffective with prescription psychotropic drugs is absurd. I don’t think pills are good answers for a lot of things people toss them back for, unaware of the known side effects or long-term effects (because some of them haven’t been around that long). The propensity of psychiatrists to augment ineffective anti-depressants with a second anti-depressant or a mood stabilizer or an atypical antipsychotic or some creative combination of all of these and the lack of long-term data on the effects of these combinations creates potential difficulties. The willingness of insurance companies to pay for pills but not therapy (which has comparable results without additional risk of constipation, hemorrhoids, hair loss, exacerbated psoriasis, seratonin syndrome, weight gain, or being catapulted into full-blown mania because of undiagnosed bipolar disorder, among myriad other possibilities) is short-sighted and not in the public interest.

    Despite lengthy recitations of potential side effects on TV advertising, doctors banking on a placebo response minimize their discussion of potential medication downsides. It’s a shame that we don’t see more support for lifestyle changes (including therapy, exercise, regular sleep and meal schedules, adequate hydration, moderate alcohol use, meditation, and sensible eating) before doctors whip out prescription pads for gerd meds (I’d rather not drink OJ before bed than have my bones crumble from using PPIs), statins (with potential liver problems, much like lithium and many other meds), GI problems that might be remedied by giving up drinking soda, and anxiety meds. Even seemingly harmless NSAIDs (ibuprofen, acetaminophen, aspirin) have serious risks.

    Encouraging people to solve their problems with a pill rather than taking the time to perform conscientious diagnosis is malpractice.

  9. Drugs are cheaper than psychotherapy. Don’t worry about the reason you are feeling depressed. Just take a happy pill!
    I went off anti-depressants because I’m afraid of changing my personality. I’m pessimistic and rarely happy. That’s part of my identity and to change that part of my personality just makes me feel fake. If I’m not happy it is because I’m under 18 and I don’t have any control over my life. My parents own me. Or I am paying thousands of dollars I don’t have to go to an University where I am lost in the crowd and am only learning that I don’t belong in such a high stress environment. Or maybe it is because I am at work on New Years Eve and don’t have any way to go home because I don’t have a car and bus service is cut off for the day. I’ll sleep at work, thank you. There is always a good reason to be depressed. I’ll happily point out the cloudy lining on any piece of silver. : )
    I guess what I’m saying is that drug induced happiness is not for me… unless its coffee. To each their own.

  10. To compare antidepressants to caffeine or alcohol is irresponsible. Additionally, if a person is using alcohol daily – often for years on end – to lift his/her mood, take the edge off, or get through the day, then it is widely considered, societally, to be a significant problem.

    What you haven’t considered – so far as I can tell – in your arguments above is that doctors and psychiatrists are considered to be voices of authority whose understood aim it is to diagnose and heal illness (whether physical or mental). I think you would be hard-pressed to find an alcoholic who has been instructed by a medical authority to drink daily to relieve – or even cure – his symptoms. And if the scotch doesn’t work, then he can switch to vodka or tequila after a few months to see if that helps…..

    Doctors and drug companies benefit far more from the medicalization of emotional issues (such as depression) than patients do, according to the mounting data that antidepressants aren’t very effective at all – and your cavalier attitude toward their treatment is a clear indication of why this really needs to change. If antidepressants are little more than a placebo anyway, then why not prescribe something non-toxic and far more effective for their ills – like therapy? Billions of dollars are at stake here and I suspect the drug companies and the medical professionals who work most closely with them are not particularly interested in seeing their profits disappear.

    If more medical professionals made their goal actually helping their patients (by whatever means – include something like antidepressants, if they were actually effective) rather than maintaining the status quo, I think we would all be a lot better off.

  11. Actually… I have no problem what people put in their bodies.

    But here’s the thing. Alcohol and coffee have never been passed off as “vitamins for brain” and “correcting chemical imbalances”. It’s passed off as healthy thing. As medicine, not as mood altering substance.

    Most people know alcohol will not help your life situation. But sadly some (including doctors) will tell you ADs will solve at least some of your problems.

    And… nobody will tell you that you to drink coffee or alcohol. And see refusal to do so as lack of interest in recovery. Which happens with ADs and other psychdrugs and the MH system. Could a therapist tell their client they will drop them unless they start drinking?

    The fact is…. there is double standard.

  12. It’s rare to find a psychiatrist willing to take off his or her mask and speak their mind, so fair play to you for that, doc. If only more of you had the guts to do it. I’m not sure the comparison to alcohol is accurate, however. Recreational drugs such as crack, speed and crystal meth would be a better fit. The pills you offer are, after all, just legal variants on these and most adults know it. For my part, I’d only ask you to stop giving them to children.

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