Mental Health Matters: Overprescribed antidepressants have harmful effects
Special to the Bonanza
Prescriptions for antidepressants have skyrocketed in the past 20 years, and rates have increased between four- and ten-fold in various age groups.
If you believe that prescription rates reflect treatment for illness or disease, we’re experiencing a depression tsunami. But you would be wrong.
There is no good evidence that rates of depression have actually increased in the past 20 years. So, what’s going on here? A lot.
Statistical analysis provided by the Center For Disease Control and Prevention, while open to differing interpretation, is compelling.
Some 10 percent of Americans age 12 and over take antidepressant medication. Women, at every level of depression severity, are more likely to take antidepressants than men; 23 percent of women aged 40-59 take antidepressants, more than any other age or sex group.
More than 60 percent of Americans who take antidepressants have done so for more than two years.
Remarkably, of those who use antidepressants, 14 percent have done so for 10 or more years.
Even in the face of 2004 FDA warnings on the hazards of antidepressant use in children and teenagers, some 2.5 percent of kids under 18 use antidepressants.
At the same time, less than one-third of persons taking an antidepressant have seen a mental health professional in the past year, and less than one-half of those taking multiple antidepressants (arguably indicating more severe depression) have seen a mental health professional in the past year.
Of equal import, only about one in three people with severe depression are prescribed antidepressants.
In terms of numbers of prescriptions and their cost, antidepressants were the third most common medication taken by Americans from 2005-2008, and the most frequently used medication in the 18-44 age group. Moreover, the second most prescribed drug class in 12013, some 519 million prescriptions, was for mental health issues.
Through March 2014, Abilify, an antipsychotic also used to treat depression, was the top selling drug in America, with sales of $6.8 billion and the antidepressant Cymbalta was number eight in sales at $4.1 billion.
To appreciate the extraordinary scale of these sales, compare them with the antacid drug Nexium at $6.3 billion and the painkiller Oxycontin at $2.5 billion.
What accounts for these numbers? The sale of antidepressants is a multibillion-dollar, highly profitable business. Yet most of the population who experience severe depression, arguably the group most likely to benefit from them, do not get treatment.
Here’s the story from my perspective. One, the pharmaceutical industry is primarily in the business of marketing medications, and the sale of antidepressants is highly profitable.
This has lead to market overreach, namely suggesting that anyone who feels sad and blue will benefit from antidepressants, when in fact many if not most people taking antidepressants don’t benefit from them.
The reasons for this sorry state are many including deeply flawed “research” paid for by the pharmaceutical industry, a limited number of mental health specialists, and the tendency of general physicians to over prescribe.
Add to this list, the stigma of consulting a mental health professional, the reluctance of many non psychiatric practitioners to refer patients to psychiatrists for consultation or treatment, and the abysmal insurance coverage for psychotherapies compared to drug treatments, and you have created a systemic problem of under prescription of antidepressants for the severely depressed population coupled with over prescribing antidepressants for the less depressed.
The propensity to overprescribe antidepressants has other harmful effects. First is the direct cost of these expensive drugs to individuals and taxpayers.
Then, an overemphasis on drug treatment limits the investment of time and resources given over to other, frequently more effective treatments.
Consumers of psychotropic medications of any sort should be informed consumers: All psychotropics have side effect profiles, and long-term usage can have debilitating effects, particularly in adolescents and the elderly.
Moreover, this class of medication, if not stopped slowly, will cause at least mild withdrawal symptoms.
If you have been feeling depressed for more than two months, you would do well to seek mental health advice. Know that antidepressants are not a first line treatment for mild to moderate depression — instead, consult a clinician who will spend 60-90 minutes with you assessing the problem and 30-60 minutes per follow-up visit.
Know that more than six months of treatment with antidepressants is generally not a sound treatment strategy except for the most severe depressions, and consult a psychiatrist if you’ve been prescribed an antidepressant for more than six months.
Perhaps most important, know that feeling depressed is part of the human genome, the human condition, and that seeking assistance for depression issues that you can’t seem to solve is a wise personal choice.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. It appears every other week in the North Lake Tahoe Bonanza and Sierra Sun. He can be reached for comment at firstname.lastname@example.org.