The New York Times reported last year that nearly one in 10 Americans takes antidepressant medication; among women in their 40s and 50s, this number is close to one in four. In short, the use of antidepressant medication in the U.S. has skyrocketed by 400 percent since 1988, leading many Americans to wonder whether this increase is due to doctors overprescribing antidepressants or whether there is simply more demand for the medication.
Of course, the answer lies somewhere in between in a remarkably harmful paradox: doctors are overprescribing antidepressants to individuals who don’t meet the diagnostic criteria for depression while those with genuine depression are not receiving the treatment they so desperately need.
According to a study published last April in the journal of Psychotherapy and Psychosomatics, nearly two-thirds of a sample of more than 5,000 patients who had been diagnosed with depression within the previous 12 months did not even meet the criteria for major depressive episode, as outlined in the Diagnostic Manual of Mental Disorders (or as it’s more commonly known, the DSM).
Regardless of whether the individuals were rightly or wrongly diagnosed with depression, the patients were overwhelmingly prescribed medication.
“It’s not only that physicians are prescribing more, the population is demanding more,” said Dr. Ramin Mojtabai, associate professor at the Johns Hopkins Bloomberg School of Public Health writing in the New York Times in 2013. “Feelings of sadness, the stresses of daily life and relationship problems can all cause feelings of upset or sadness that may be passing and not last long. But Americans have become more and more willing to use medication to address them.”
Although this implies that doctors and psychiatrists are overprescribing antidepressants, the flipside is that individuals who meet the diagnostic criteria for depression often fail to receive the medication they need; for example, a 2008 study by the CDC also found that almost two-thirds of those with severe symptoms of depression don’t take antidepressants at all.
It’s absolutely normal to have bouts of sadness and depression from time to time. It’s part of human nature. Yet the line between those who actually meet the criteria between depression and those who don’t often becomes blurred.
Serotonin, a neurotransmitter, influences the part of the human brain that affects mood and social behavior, including appetite, sleep, memory and sexual desire; as such, antidepressants target and increase serotonin.
Prozac, the leading anti-depressant medication being sold in the United States, reported net sales of $23.1 billion in 2013. They are making a fortune convincing the masses that they are depressed; as a cure, they offer the magic solution: an anti-depressant pill.
From a business aspect, it is genius. From an ethical point of view, it is highly questionable, especially in light of research that suggests that antidepressants are not particularly effective at treating the condition. For example, a 2008 study conducted by University of Hull psychologist Irving Kirsch compared 35 trials of major antidepressant medications, including Prozac, Effexor and Paxil.
The study found “virtually no difference” between drugs and placebos for the moderately depressed; in addition, it found only a relatively small difference even in the very severely depressed. “It seems to be the same pattern no matter which antidepressant you look at,” said Kirsch, writing in Forbes in 2010. “Most of the benefits patients get from antidepressants may be the placebo effect.”
Building off this research, a 2010 study published in the Journal of the American Medical Association compiled the results from six antidepressant trials that included mild and moderate cases, totaling 718 people overall. The study found virtually no difference between placebos and antidepressant drugs for those with mild or moderate depression.
“The evidence we now have suggests there is very little benefit [from antidepressants] for people with less than very severe depression,” said study co-leader Robert DeRubeis, a psychologist at the University of Pennsylvania in the 2010 Forbes article. He went on to say that mental health professionals may want to consider alternative treatment options, such as cognitive therapy and exercise before resorting to medication in the milder cases.
Anti-depressants are showing to be a highly profitable product that the pharmaceutical industry produces; and as such, it will undoubtedly continue to be marketed to the masses in the coming years for one reason: profits. And it will succeed in that. Patients do not have time to be depressed, and doctors do not have time to conduct a rigorous psychological examination of the patient; consequently, prescribing antidepressants has become almost a reflexive reaction for health care professionals.
A harmful paradox plagues the antidepressant industry: although antidepressants appear to be overprescribed in the U.S., those who actually meet the diagnostic criteria for depression usually fail to receive the treatment they need.
