If It's Morning In America (Again)

[Gary Sisco]

why are so many people so depressed?

Antidepressant Use By U.S. Adults Soars
Cost and Risk Questions Mount in Face Of Overall Surge in Prescription Drugs

By Shankar Vedantam
Washington Post Staff Writer
Friday, December 3, 2004; Page A15

One in 10 American women takes an antidepressant drug such as Prozac, Paxil or Zoloft, and the use of such drugs by all adults has nearly tripled in the last decade, according to the latest figures on American health released yesterday by the federal government.

Those numbers are among a broad array of changes in health and health care use in the United States identified in the report. It confirmed that prescription drug costs are soaring faster than any other area of medical care as ever-increasing numbers of Americans take drugs for psychiatric conditions, to lower their cholesterol, to control asthma and for a wide range of other reasons.



In 2002, the latest year for which data were available, the total tab for health care soared to $1.6 trillion -- of which prescription drugs accounted for $162 billion, the report found. Drug costs rose by 15 percent over the year before, driven by a combination of more expensive medicines and increased use.

The report comes at a time when questions are growing about the costs and safety of many prescription drugs. The Food and Drug Administration recently concluded that antidepressants can increase the risk of suicidal behavior among children, and the manufacturer of Vioxx abruptly recalled the popular painkiller for safety reasons. A senior FDA official testified in Congress last month that he believes five other approved drugs are dangerous and should be taken off the market.

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) showed some of the largest increases in use, the report said. By 2000, the proportion of adults using such drugs had nearly tripled, compared with the data set that ended in 1994.

In 2002, more than one in three doctor's office visits by women involved a prescription for an antidepressant, said Amy Bernstein, project director for the report issued by the Center for Mental Health Services of the Centers for Disease Control and Prevention.

"It gives you an idea of what is happening during these visits," said Bernstein, who explained that the statistic included patients already on the drugs and those getting a new prescription.

The number of children getting psychiatric drugs also soared. In 2002, about 6 percent of all boys and girls were taking antidepressants, triple the rate in the period 1994-96. And about 14 percent of boys -- nearly one in seven -- were on stimulant drugs in 2002, double the number in 1994-96, the report found. Stimulant drugs are usually used to treat attention deficit disorder.

The number of adults taking cholesterol-lowering statin drugs nearly quadrupled from 1995-96 to 2001-02, the report found.

Overall, 44 percent of all Americans, including children, were taking at least one prescription drug in 1999-2000, a statistically significant 5 percent increase since 1994. The proportion taking three or more prescription drugs increased from 12 to 17 percent during that same time, Bernstein said.

"Factors affecting the recent increase in utilization of medications include the growth of third-party insurance coverage for drugs, the availability of successful new drugs, marketing to physicians and increasingly directly to consumers, and clinical guidelines recommending increased utilization of medications for conditions such as high cholesterol, acid-reflux disease, and asthma," the report concluded.

Julie Zito, a pharmaco-epidemiologist at the University of Maryland at Baltimore, said it is difficult to characterize as good or bad the increased use of drugs without studies that ask how people are faring as a result.

"As the numbers keep growing year after year after year, and larger proportions of the population appear to be suffering from conditions or getting treatments they may or may not be benefiting from, that would be an argument to follow large cohorts of patients in community studies to assess effectiveness and safety," she said.

The drug industry's umbrella trade group said the increased use of medications is a good thing.

"We have more medicines and better medicines for more diseases, and patients are being more effectively treated," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America. "They are living longer largely because of new treatments, and that is good news."

Trewhitt said there are numerous examples of how increased use of drugs -- such as cholesterol-lowering statins -- reduce overall health care costs by controlling heart disease and reducing more expensive hospitalizations.

On the increase in antidepressant use, Trewhitt said, "I don't know how to read that. We just don't have any information -- it's not something we have studied."

[willy]

Why are entire families, including their pets, on anti-depressants these days? How in the hell can anyone tell that Fido is depressed? Why are our public schools shoving drugs down our kids throats these days to calm them down?

Something is terribly wrong here, and drugs ain't the answer.

[Ennis Snavely]

My mother is undergoing an ordeal that may be due to being over medicated for a chronic condition. She was on 7 different meds (I won't even mention how much she would need to spend a month if she didn't have some insurance - BTW, she's too "rich" for the new Medicare plan and the bogus Medicare "discount" card gives little if any discount - but she managed to find private insurance that pays up to a certain cash amount for her drugs). Somehow her health went south either due to some physiological change. Whether that change was caused by the meds or was just part of the disease she's suffering from, who knows. Fortunately, they seem to be aware of what's going up and the docs are weaning her off all the stuff she's on.

As for psychiatric drugs, there's no doubt that they are over prescribed. It seems that we have attached a pathology to any human behavior that's just off the mean. That said, some people have organic brain disorders that respond to some of these new meds. It's also been pretty well established that medication alone isn't adequate; a combination of traditional talking therapy and meds is what works well for a lot of people.

[Pete C]

This is better:

[Pete C]

[Pete C]

At any rate, many people should be on these drugs and benefit from them greatly, but clearly, as with many medications, they are often prescribed as shortcuts. I know somebody who was going through some shit in her life. She was depressed, because she was going through some shit in her life. she didn't as far as I know, have a history of depression. Having a valid reaction to specific bad stuff is not the same as clinical depression, and I don't think these chemicals are the answer, but she was prescribed one of these drugs. Whatever.

[vibes]

My mother recently started taking Prozac, which greatly concerns me. I had no idea, but apparently she recently started having anxiety attacks. I don't know how common it is for people who take antidepressants, but she's been pretty open about her anxiety and her need for medication, which I think is really positive. She's now the same age her mother was when she passed away, which is the primary cause for her anxiety attacks.

I've never known anyone else that has taken Prozac, but I'm curious about how long it takes before people start to see benefits from it. My father says he hasn't noticed any changes in my mother, and she's been on it for about a month now.

[cookie]

It's all a matter of the right drugs for the right condition. I have a history of depression and they first tried to treat it with SSRI's. Didn't work. Just made me race and sent my thoughts out of control: mania. When I was properly medicated for bipolar disorder over 2 years ago, it made all the difference in the world. I can still be sad, or pissed off, or lonely but I don't feel like I want to die. And I know it's the right medication because I made the mistake of going off them after being sober for a while. Thought that maybe it was the alcohol that had made me so depressed and fucked up in the first place. Turned out it wasn't.

So, the right medication for the right condition is a godsend. But there's a difference between sad, frustrated, bored, tired and truly down and out suicidally depressed. Like Pete, I think that clinical depression is being medically treated in cases where once the cure was the passage of time and forming some sort of support network (therapy, groups, etc.).

[shrugs]

People used to just throw back a few down the hatch. Now it's not cool anymore. I still prefer happy hour therapy myself. I've been through a lot this year but I believe in pulling your bootstraps up and getting on with life.

On The Sunny Side Of The Street, baby

[cookie]

Originally Posted by shrugs

People used to just throw back a few down the hatch. Now it's not cool anymore. I still prefer happy hour therapy myself. I've been through a lot this year but I believe in pulling your bootstraps up and getting on with life.

On The Sunny Side Of The Street, baby

I wish that had worked for me. Sometimes it could be fun (happy hour therapy), but it got less fun. Sometimes you can haul all you want on those bootstraps and still get nowhere. Being unable to "just snap out of it" is one of the factors of true depression.

That doesn't mean you have to go on Zoloft for a hangnail or a bad hair day...

[shrugs]

It probably helps that the happy hour joint I go to has Al Green, Shuggie Otis, Lady Day and Duke on the jukebox.
Music has gotten me through my share of woes.
Some good herb shared with friends helps out too.....

Originally Posted by cookie

I wish that had worked for me. Sometimes it could be fun (happy hour therapy), but it got less fun. Sometimes you can haul all you want on those bootstraps and still get nowhere. Being unable to "just snap out of it" is one of the factors of true depression.

That doesn't mean you have to go on Zoloft for a hangnail or a bad hair day...

I agree completely, Cookie.

Problem is, that's exactly what can happen if you have the right(or wrong, really)doctor.

It's an over-medicated society. Nobody can deny that.

[cookie]

Originally Posted by shrugs

It probably helps that the happy hour joint I go to has Al Green, Shuggie Otis, Lady Day and Duke on the jukebox.
Music has gotten me through my share of woes.
Some good herb shared with friends helps out too.....

Agreed. Music is good clean medicine and good herb shared is good herb.

[kenny weir]

Joke: What do you call a bunch of New Zealanders on Prozac? Once Were Worriers!

[Gary Sisco]

I'm more interested in the apparently widespread depression than in what benefits or harm can arise from the medications.

On the other hand, I had a doctor who wanted to put me on a drug for depression. I told her that I'd do some research on it and get back to her, as I don't just put chemicals in my mouth because someone, doctor or no, recommends it. The drug, it turned out, according to both the manufacturer and the FDA, had never been tested in controlled circumstances, for any group of people who'd taken it for longer than *six weeks.* Sorry, that's not a long-term study, folks. Most of them don't even take effect for several weeks to begin with. I'm more interested in what happens to the people who take them for long periods of time, and that is an answer that no one can give, for many of these drugs, if only because a lot of them haven't even been around for any "long term" yet. No one knows.

And it turns out, if you really look into it, that most doctors base their recommendations on ... you guessed it, manufacturer's salespeople's hype.

Good luck to us all.

[Dr Dave]

I had ten years of talk therapy to treat depression. But I never really got anywhere until I started taking SSRIs. I'm lucky: They work, I've never had side effects. I'm interested that anyone would prescribe Prozac for anxiety. It has a brief anti-anxiety effect when you first take it, but that lasts maybe a few days.

As a person who did his share of drug abuse in the Dear Departed Days, I don't think I have standing to make any criticism of people who take prescription drugs. On the other hand, there is clearly overmedication going on in the U.S. on a scale that boggles the mind. I find it impossible to believe that so many boys need Ritalin to make it through the day. When I was growing up, I never even heard of Ritalin until I read about it in "The Electric Kool-Aid Acid Test."

My wife, who used to work in a branch of the pharmaceutical industry, has been very skeptical of most new drugs put on the market in the last ten years or so--too many me-too drugs, and too many, like Vioxx, that turned out not only to be ineffective, but actually dangerous.

[Gary Sisco]

I'm not criticizing anyone who takes drugs. I'm just asking why there are so many depressed people out there, if everything's groovy. That's all.

I do, however, think it's a crime to be pushing these chemicals into millions of kids without anyone, anywhere, having any notion whatsoever of the long term effects of doing so -- not only for the kids themselves but also for the rest of us, who will have to pay, one way or another, if it turns out to have been a stupid thing to have done. Which it likely will.

[cookie]

I think alot of what is being diagnosed isn't truly depression. I also think that some people are willing to accept a "quick fix" where one may exist. The drug company advertising is relentless, the world is a fuckin' political and social nightmare, and hey, if you can take an anti-anxiety drug or a drug to improve your sense of well-being, why then, why not???? I think alot of people feel entitled to never feel miserable.

[Dr Dave]

Originally Posted by cookie

I think alot of what is being diagnosed isn't truly depression. I also think that some people are willing to accept a "quick fix" where one may exist. The drug company advertising is relentless, the world is a fuckin' political and social nightmare, and hey, if you can take an anti-anxiety drug or a drug to improve your sense of well-being, why then, why not???? I think alot of people feel entitled to never feel miserable.

Not sure how I feel about that last line, Cookie. Anti-depressants don't keep me from being unhappy. They keep me from falling into a black hole of self-loathing. I assure you, there is a difference.

[tippy]

I am pro-medication. It can be tricky trying to find one that helps you and I do prefer that they be administered by psychiatrists or ideally that gp's would more carefully monitor patients they've prescribed for. I do understand that to leave it only in the hands of psychs means that people who need the meds are less likely to access them. Depressed people are often the last people to ask for help. It's against the nature of the disease to seek help. I guess the conundrum is that overprescription means more depressed people will get help and more people who don't really need the meds will be medicated.

I was depressed when I was working for the man. Now I'm depressed for not working for the man. Hee hee. I don't know what the increase in depression is...that enlightenment brings the expectation of better living, imbalanced focus on achievement, general human disconnect? I sorta feel like sane people, eyes open, would be depressed, but then that's no way to live and the depression left untreated sets the negative in stone physiologically. It's a weird f'ing spiral, man.

[cookie]

Originally Posted by Dr Dave

Not sure how I feel about that last line, Cookie. Anti-depressants don't keep me from being unhappy. They keep me from falling into a black hole of self-loathing. I assure you, there is a difference.

Of course, Dave, and believe me, I know that black hole. All I'm saying is that I do think some people embrace medication where there may be non-pharmaceutical solutions they haven't yet tried. Trust me, I'm pro meds all the way and wouldn't dream of going off mine, but I tried alot of other things before it became apparent that I really NEEDED to be medicated. And yes, I can still feel miserable, but I don't feel suicidal.

BWTFDIK

[frankiepop]

mental pain is good for people.

...in my opinion, the better use for psychotropic drugs...is GENERALLY for recreational use and not medical.

[frankiepop]

i want to that my post was only a mere generalization and it was not intended to be a conclusive statement.

i also want to be clear that it was written without any prior knowledge of the posts above....i didnt read them until after i posted and in no way do i judge others needs in this area and to what their needs may require.

[crawjo]

In my completely unscientific opinion, depression is rampant in our society because we are too focused on superficial materialism, and at the end of the day, people need more reason to feel good about life than that they have the best junk money can buy.

The other possibility is that people have always been depressed in the numbers they now are: the difference is that because there are now medications to counteract the depression, it seems like a "new" problem when in fact it is just an old problem getting new attention.

[Dennis Gonzalez]

I think that many people are denying that a lack of spiritual satisfaction - something to believe in - and I don't mean organized orchestrated religion either or a political viewpoint - has anything to do with the high levels of depression. I am not talking about physiological causes, which it seems several of our colleagues here suffer from, and which the use of medication really helps. People are not as kind to each other, or as loving, as I think we all used to be. Our liberties, which are very necessary for our spirits to soar, and which keep us from getting what could be termed mental claustrophobia, are being taken away fairly quickly, whether you are right or left or in-between (or even at the extremes) politically.

We are not sure who to trust, as our innocence has been wiped out by the traumatic and the instantaneous knowledge of the traumatic. Our leaders (again on all sides - except for a very few) are advocating violence as a way to deal with trouble and to "set people straight", something the schools and your teachers tried (and still try) to teach students to not resort to. Namecalling has become the fashion, especially if you disagree with someone or if someone disagrees with you. Rude and violent gestures and language are argued for as being not only useful for dealing with trouble, but it is argued that it is the completely correct thing to do if one so chooses. Just look at how much time is spent in these forums arguing for the right to use rudeness and sexist and racist language, and then people get offended if you call them on it and can't remember being so insulted in their lives.

All these things I feel are leading us down the path of depression. Our minds can't handle so much negativity, and in confusion, turn inward, causing self-destructive thoughts.

Food additives and chemicals in the air affect what our bodies have to deal with, and frequently the mind suffers from this as well.

We don't tell each other that we love, or even like each other anymore. We don't bless each other anymore. We don't hug like we used to and touvh each other when we talk, because we are divided.

I think those factors have alot to do with this new epidemic of depression.

[Pete C]

Originally Posted by crawjo

In my completely unscientific opinion, depression is rampant in our society because we are too focused on superficial materialism, and at the end of the day, people need more reason to feel good about life than that they have the best junk money can buy.

The other possibility is that people have always been depressed in the numbers they now are: the difference is that because there are now medications to counteract the depression, it seems like a "new" problem when in fact it is just an old problem getting new attention.

In my unscientific opinion the first paragraph is trite b.s., and the second is probably pretty accurate.

[crawjo]

Originally Posted by Pete C

In my unscientific opinion the first paragraph is trite b.s., and the second is probably pretty accurate.

In my unscientific opinion, your description of my first paragraph is trite b.s., but your description of my second paragraph is probably pretty accurate.

[frankiepop]

i agree that western literature and historical readings suggests that this is not a new phenomenen, but i dont believe that this is the way most of the depressed have to exist with or without medication.

surrender suri, a world history professor from india, stated that in america the universities have young students who have everything. cds, cars, food, stereos, computers, nice places to live, money and yet he looked into their eyes and saw sadness.

contrastly, students in india sometimes were virtually starving in abject poverty with maybe only one meal a day and virtually no possessions and they were happy.

[Gary Sisco]

Who in the world would use a psychotropic drug for recreation? What, you want to learn how to do the thorazine shuffle?

I agree with Cookie that many people are being wrongly diagnosed (and hence wrongly medicated) but there is still, it seems, a huge number of people in this great land who find life to be depressing as all hell, apparently. Seems like if this is the greatest society ever in all of history, that's kind of a disappointing "end of history." Depressing, even. Thousands of years of social evolution so that everyone can have a Wal-Mart on the corner and at least four "convenience" stores to choose from, all selling exactly the same stuff. If that don't make you an atheist nothing will. ;-)

I happen to agree with Dennis's diagnosis, though I think there are as many different solutions to the malaise as there are people -- if they lived in a sane and human society. Which they don't, but could, if they'd get up off of their asses and make one for themselves. Another thing I know from experience to be true, even if an old Maynard G. Krebbs admirerer like myself is loathe to admit it. Try *working* and sweating and getting dirty once in a while. It does wonders for the mind and spirit. I'm not kidding. Life as a couch potato and life with the tube as focus supreme is depressing. And will be, medications or not. The meds will just give you something else yet to have to pay for on a regular basis, if you're going to live like that.

I like these kinds of conversations, which I've had several times with VA shrinks and counselors:

Doc: What you're suffering from is a major clinical depression.

Me: No, it's not. I have an unrelenting and irresolvable social and political anger, with no outlet.

Doc: Anger is often a symptom of depression.

Me: Yeah, and it's also often a symptom of anger, dipshit.

And etc.

Someone's going to have a hard time convincing me that my take isn't right: These guys either 1) are lazy and not very bright, or 2) they really do get kickbacks from the drug dealers, er, companies. I'm taking myself off of Babylon's drugs, either way. I've decided, in any case, that anything the VA wants to give vets for free isn't something that one should take. I mean, they don't want to give us anything else, so if they do, whatever it is must be highly suspect.

All of that aside, I find my salvation in music, my partner and good friends, my animals, and, not least, the healing of the nation, the herbs that grew 'pon King Solomon's grave. I'm not joking. Every evening when the work is done, the ritualized, meditational aspect of the pipe and great music is very much a spiritual discipline and practice for I-man -- the only one I follow -- and it helps more than all of Babylon's drugs combined, free or not. If it weren't for that -- music soothing the savage beast, along with some hard work to make you tired enough to appreciate the ritual and meditation -- shit would really be tough, no joke.

[Gary Sisco]

Prognosis? Murray Bookchin said it best at the end of his *Re-Enchanting Humanity,* where he said that human beings are too intelligent not to live in a rational society but it remains to be seen if they are intelligent enough to create one.