"One in nine Americans over age 12 takes antidepressants"

[StusBlues]

Holy Crow!

That seemed high to me, but it's confirmed by the CDC site, which I consider holy writ on matters medical and empirical.

Cecil strongly implies that these meds are being overprescribed with insufficient oversight, and I am inclined to agree with him.

[inedible knapsack]

I feel certain that if I tallied all the people I know, then took account of all who have openly confessed to using psychiatric meds, I'd be around 5%. And that's people who are seemingly proud of the fact; no doubt in my mind there are plenty more who aren't willing to divulge to every passing acquaintance.

I've long thought the state of psychiatric medicine in America is horrific. My friends who've struggled with depression have suffered dearly at the hands of psychologists who overprescribed meds with abandon. Being a layperson, I don't claim to know the answers to what's ailing us here in America, whether depression is really becoming more commonplace or if we're gradually deciding that even fleeting, situational sadness is too much to bear, but something's gotta give.

[Exapno Mapcase]

One thing about those numbers. Anti-depressants have numerous so-called "off label" uses, in which they are prescribed for something other than depression. They're used to control symptoms in Irritable Bowel Syndrome, e.g.

I don't know how this compares to the primary use figures, but the statement "One American in 12 takes antidepressants despite having no depressive symptoms whatsoever" can probably be largely explained by this without having to look for physicians handling them out like candy. Doctors might, but I think those numbers exaggerate the real situation.

[Mithras]

Originally Posted by Exapno Mapcase

One thing about those numbers. Anti-depressants have numerous so-called "off label" uses, in which they are prescribed for something other than depression. They're used to control symptoms in Irritable Bowel Syndrome, e.g.

I don't know how this compares to the primary use figures, but the statement "One American in 12 takes antidepressants despite having no depressive symptoms whatsoever" can probably be largely explained by this without having to look for physicians handling them out like candy. Doctors might, but I think those numbers exaggerate the real situation.

If anti-depressants have so many off label uses that that explains their being used by over 8% of the population, they've got to be among the most miraculous drugs ever created.

[StusBlues]

Originally Posted by Mithras

If anti-depressants have so many off label uses that that explains their being used by over 8% of the population, they've got to be among the most miraculous drugs ever created.

Given the hype from the legalization crowd, I'd say the same thing about cannabis.

[thelurkinghorror]

Originally Posted by Cecil

One American in 12 takes antidepressants despite having no depressive symptoms whatsoever.

What percentage of these people take antidepressants for other symptoms? such as anxiety, which is a perfectly cromulent usage. Any symptom causes by a dearth of serotonin and/or norepinephrine.

Originally Posted by Cecil

A review of 96 studies published from 1980 to 2005 concluded the placebo effect was likely responsible for 68 percent of the improvement seen in patients taking antidepressants. Another review pegged it at 84 percent. What’s more, the placebo effect appears to be growing over time.

Is this the same as saying that 32% of the improvement is due to the effect of the antidepressant? Because, depending on the model, this sounds like it could be a very large effect size. Hardly something to be ashamed of.

If there were truly no difference, then countless studies all did improper research, or even more unlikely, all found results when they shouldn't have, without poor research (the "rolling the dice" paragraph is telling, wish he went into that more). We're not talking about non-FDA supplements like St. John's Wort. They need to demonstrate a pretty clear effect. Whether they are as effective as advertised is another issue.

I have a problem with how they're prescribed sometimes, and have had a spotty history with their efficacy in the past. But I'm inclined to believe that antidepressants work and that I'm not in league with Xenu. It boggles the mind though that many of these people aren't regularly meeting with the psychiatrist, even if it's a 15 minute session where the main questions are a) is it working, and b) any side effects?

[Anaamika]

The thing is, I just don't believe medicine is enough. It may normalize people enough to deal with their issues but then they have to deal with their issues, too. A combination of drugs and therapy seems like the best option.

[Canuckistan Bob]

One has to be careful. Are antidepressants over prescribed in the US? You betcha. Way way overprescribed. But that wasn't the question, which was, are antidepressants effective? And the answer to that, when prescribed for real actual serious clinical depression, is a very clear and unqualified yes. (Speaking as a social worker, and as a member of a family with some clinically depressed members.)

The depression has to be real, and serious, at a clearly diagnosable clinical level; not a normal depression caused by life events, where they won't help you at all. If if you suffer from existential angst or 1st world over-entitlement syndrome, they and therapy may well have a strong placebo effect. But if you have a severe serotonin deficiency, there is nothing placebo about them, and all the therapy and salt pills in the world won't help you.

And they don't "make you feel good." SSRI's make you feel something like normal, when you feel unnaturally bad (and the "unnaturally" is the key point here-- ie serotonin deficiency). Cocaine, opiates, etc. make you feel unnaturally good (at a terrible price). SSRIs do NOT.

[Annie-Xmas]

Speaking on a personal level, when I was (wrongly) put in the cuckoo's nest, it took two-fucking-hours to get drugs, 14 hours to get food, and 38 hours to get soap and toothpaste. That explains all the skinny, dirty druggies in this country.

Seriously, if someone reports to the police that you are suicidal, you will be locked up and drugged. And that is just plain wrong.

[Exapno Mapcase]

Originally Posted by Mithras

If anti-depressants have so many off label uses that that explains their being used by over 8% of the population, they've got to be among the most miraculous drugs ever created.

This is exactly the kind of misunderstanding of antidepressants I was talking about.

High rates of off-label prescriptions for antidepressant, anticonvulsant and antipsychotic drugs

A University of Georgia study has found that three-quarters of people prescribed antidepressant drugs receive the medications for a reason not approved by the federal Food and Drug Administration.

What kind of off-label uses?

Generalized anxiety disorder; Premature ejaculation; Migraine headaches (prophylaxis); Diabetic neuropathy; Fibromyalgia; Neurocardiogenic syncope

Another list from RXlist.com

Some off- label uses of antidepressants include, but are not limited to: fibromyalgia, chronic urticaria (hives), hot flashes, hyperhidrosis (drug-induced), pruritus (itching), premenstrual symptoms, bulimia nervosa, Tourette syndrome, binge eating disorder, etc.

Those are common problems that tens of millions have. You can certainly argue that drugs are misused for depression and related problems, but the drugs themselves are legitimate, work on numerous problems, and are wonderful if they work. I have IBS and an antidepressant is the only thing that controls the symptoms. Why? Probably serotonin uptake, just like a million other problems. Off-label drug use is as real as using aspirin.

[Ferret Herder]

"Antidepressants" aren't one or two medications or even one or two medication classes. There are quite a few out there, they influence neurotransmitters in varying ways, and yes, they are frequently used off-label because they work for those indications. I took a low dose of one for months as a migraine preventative. It didn't make me "high" or "hyper" or anything other than much less headachey, which in itself did make me happier.

[Beware of Doug]

Originally Posted by Annie-Xmas

Speaking on a personal level, when I was (wrongly) put in the cuckoo's nest, it took two-fucking-hours to get drugs, 14 hours to get food, and 38 hours to get soap and toothpaste. That explains all the skinny, dirty druggies in this country.

Seriously, if someone reports to the police that you are suicidal, you will be locked up and drugged. And that is just plain wrong.

You're an instant second-class citizen. And that is wrong. But I can promise you that a lot of paranoid people who have never known a mentally ill person sleep better at night knowing that you are being denied your basic human needs, because they believe you are not human and need what they consider tough love. Crushing out what little humanity you call your own, they feel certain, will help make the world a better place.

[SerafinaPekala]

Remember: 90% of Americans are on some type of psychotropic medication. Usually because of the 10% that should be but refuse. <-- my personal observation.

[moriah]

Originally Posted by StusBlues

Given the hype from the legalization crowd, I'd say the same thing about cannabis.

It'd be funny if cannabis turns out to the the one true anti-depressant that the majority of people who take anti-depressants need to calm down.

True biologically-based depression, however, as pointed out above, needs real anti-depressants. It's wrong, wrong, wrong that any old doctor can prescribe these without doing a true mental health evaluation or full endocrinal evaluation of the patient. Wrong as in there should be laws to prevent it.

Situational and environmental depression needs to simply take a hit and relax. It's the kind of self-medication people have been doing for ages with alchohol, but cannabis would be less problematic (mind you, I'm not saying unproblematic).

An even better solution would be teaching of better coping mechanism skills, relaxation exercises, proper nutrition and exercise, and life-style changes to reduce stressors, end dysfunctional relationships, and a change of social attitudes which encourage violence, revenge fantasies, hypersexuality, poor self- and body-image, consumerism and indulgence as panaceas, and the use of alcohol and harder drugs. And furthermore, developing social attitudes of patience and service, which have been shown to reduce depression.

[SerafinaPekala]

^^ ITA Moriah.

[Merneith]

Originally Posted by Ferret Herder

"Antidepressants" aren't one or two medications or even one or two medication classes. There are quite a few out there, they influence neurotransmitters in varying ways ...

<snip>

This is important and I wish Cecil had been more granular in his analysis. I also wish he'd been more explicit about what symptoms the various studies were looking treat. Was he including the anti-psychotics or lithium? What did the studies show for people with a)personality disorders, b) bi-polar, c) delusions, d) suicidal impulses?

For an article titled, "Do antidepressants only work because of the placebo effect?", I would have thought there would be more discussion of "What is an antidepressant?" and what do we mean by, "Work?"

[gamerunknown]

Originally Posted by Annie-Xmas

Seriously, if someone reports to the police that you are suicidal, you will be locked up and drugged. And that is just plain wrong.

Depends on the country. While type 1 errors are pernicious and hard to correct, there are plenty of type 2 errors too. I have a schizophrenic member of the family who's threatened suicide and we've divulged this information to numerous professionals, none of whom have kept him in a ward for longer than two or three days.

Originally Posted by inedible knapsack

My friends who've struggled with depression have suffered dearly at the hands of psychologists who overprescribed meds with abandon.

It's not a neutral cite, but the APA believes the fault lies with physicians not trained to deal with mental health issues. If you think about it, therapy is costly: psychiatrists and therapists stand to benefit from giving courses of therapy.

[Annie-Xmas]

Originally Posted by gamerunknown

Depends on the country. While type 1 errors are pernicious and hard to correct, there are plenty of type 2 errors too. I have a schizophrenic member of the family who's threatened suicide and we've divulged this information to numerous professionals, none of whom have kept him in a ward for longer than two or three days.

So why force a person to take dangerous mind altering drugs for two or three days, when it takes about a month for them to (supposedly) have any effect?

Well, I guess it makes money for the drug companies, particularly if you are convinced you need to take them for the rest of your life.

[JoelUpchurch]

this is the part I noticed:

Nearly three quarters of all antidepressant prescriptions are written without any diagnosis of a psychiatric problem. Primary-care physicians are much more likely to prescribe these drugs than specialists — one in 11 visits to a primary-care physician results in a new prescription or refill. In nearly 80 percent of these office visits where there’s no psychiatric diagnosis, there’s also no specific psychiatric complaint from the patient.

From my experience, when people have multiple meds are likely to be taking an antidepressant.

[Jackmannii]

Originally Posted by Annie-Xmas

So why force a person to take dangerous mind altering drugs for two or three days, when it takes about a month for them to (supposedly) have any effect?

You may be confusing antipsychotic meds (i.e. Haldol) which have a much quicker effect with antidepressants, which often themselves take maybe a couple of weeks to start showing effects.

Originally Posted by Anaamika

The thing is, I just don't believe medicine is enough. It may normalize people enough to deal with their issues but then they have to deal with their issues, too. A combination of drugs and therapy seems like the best option.

This sounds lovely in theory, but in the first place clinical depression is commonly caused not by "issues" but by chemical deficiencies/alterations which antidepressants address. And while it may be helpful for some people to have psychiatric therapy, that has a dubious evidence-based success rate, and is expensive and time consuming - not a workable option for most.

While antidepressants are likely overused, in my opinion it's a terrific thing they came along for clinical major depression as an alternative to plowing through long unproductive sessions with shrinks, getting ECT and losing big chunks of one's memory, or suffering for years while being told to "get over it".

[SpoilerVirgin]

Annie-Xmas - I agree about the overuse of anti-depressants, and medications for mental health in general. I'm wondering what you think should happen if someone calls the police because a loved one is threatening suicide? What should be the next step to ensure that the person is given appropriate help and doesn't harm herself or others?

[Hershele Ostropoler]

Originally Posted by Exapno Mapcase

One thing about those numbers. Anti-depressants have numerous so-called "off label" uses, in which they are prescribed for something other than depression. They're used to control symptoms in Irritable Bowel Syndrome, e.g.

That's the first thing I thought of. Any MAOI, any SSRI, anything that has among its effects the alleviation of clinical depression is an anti-depressant, regardless of what any given patient is taking it for.

It's like saying BIGNUM% of women are on anti-PCOS medication, why are doctors diagnosing so much PCOS?

Originally Posted by Anaamika

The thing is, I just don't believe medicine is enough. It may normalize people enough to deal with their issues but then they have to deal with their issues, too. A combination of drugs and therapy seems like the best option.

This isn't wholly wrong, just mostly.

One the one hand, I mean, I've semi-facetiously suggested renaming depression to "neurochemical anomaly 3A," because when someone says "I have depression" people like you hear "I'm a mopey whiner who refuses to face my problems" and maybe if I just put in the effort to learn to look at things correctly I wouldn't need these so-called glasses.

But a person who has a mental illness learns all sorts of tricks and adaptations and workarounds -- not always consciously. And some of those tricks will prove maladaptive once the neurochemical issue is being dealt with, and then they have to be unlearned. So again, not wholly wrong.

[Beware of Doug]

Originally Posted by Hershele Ostropoler

[...]I've semi-facetiously suggested renaming depression to "neurochemical anomaly 3A," because when someone says "I have depression" people like you hear "I'm a mopey whiner who refuses to face my problems" and maybe if I just put in the effort to learn to look at things correctly I wouldn't need these so-called glasses.

There will always, always, be condescending people. Especially with chronic depression so often misunderstood as a kind of moral failure. Best not to engage them at all - it only gives them the excuse to whack you with the mallet of moralization all over again.

The card you might play in your own mind, however, is, "I'm acknowledging my condition. That's step one to facing it. What this person means by 'face it' is 'ignore it - sit on it - get it out of my face'. They don't understand or care, and I don't owe them any room in my head."

[purplehaze2007]

I have been on two antidepressants for many years, and I am not depressed.

Both are used off-label.

1. Old-style tricyclic, to treat chronic muscle pain. It does a much better job than narcotics, and is not addictive.
2. SSRI, to treat migraines.

More granularity is needed to describe how, and whether, antidepressant use is justified.

[Washoe]

Originally Posted by Annie-Xmas

Speaking on a personal level, when I was (wrongly) put in the cuckoo's nest, it took two-fucking-hours to get drugs, 14 hours to get food, and 38 hours to get soap and toothpaste.

So what was the upshot of all that? Did the piece of shit who framed you ever get what was coming to him/her/it? Did you ever convince the knuckle-dragging judge that no crime was committed, and the person had filed a false police report?

[Annie-Xmas]

Originally Posted by SpoilerVirgin

Annie-Xmas - I agree about the overuse of anti-depressants, and medications for mental health in general. I'm wondering what you think should happen if someone calls the police because a loved one is threatening suicide? What should be the next step to ensure that the person is given appropriate help and doesn't harm herself or others?

First of all, there is no way to keep someone who is really suicidal from committing the act. When I was locked up, I got a conversation going with the other patients about how they could commit suicide in the hospital.

I would recommend talking to a person to verify what's going on before shoving drugs down their throat like candy.

Why is it that no one has brought up the dangerous side effects of these drugs, including the fact that they make people suicidal?

[Ferret Herder]

Originally Posted by Annie-Xmas

Why is it that no one has brought up the dangerous side effects of these drugs, including the fact that they make people suicidal?

No one? What, like the FDA which regularly slaps new black box labeling on them?

Not to mention that many times, last I saw the research, a big part of the reason for the suicide increase is because the hugely depressive person is better than near-catatonic now, and has enough energy and motivation to kill him/herself, but isn't quite well enough yet to believe that's not the answer.

[Annie-Xmas]

I meant no one in this thread, and Cecil himseld didn't mention the "side effects." Nor did the person who gave them to me.

Isn't it odd that when nature provides the means to keep a suicidal person from committing the act, people think that giving them drugs that might maybe make them able to actually do it is the answer.

[Irishman]

No one is giving them drugs so they can commit suicide. The intent with antidepressants is to affect the brain chemistry balance to actually remove the depression. However, it isn't an exact science. Like everything with biological systems, there's a lot of individual variation that affects how things actually work.

Yes, it is a risk to give antidepressants to a suicidal person. The thing is, they are not supposed to be delivered in isolation. There's supposed to be a lot of things going on, including counseling. The point of a severely depressed person is that some improvement may counteract the lethargy but not remove the suicidal thoughts. That's definitely not ideal.

But leaving suicidal people alone isn't the answer, either.

[cymbolguy]

Another off-label use: sleep aid. Mirtazapine is an anti-anxiety medication that, to quote the psychiatrist who first prescribed it to me, "fell out of favor" because it made its users so darn sleepy.

The sleep from mirtazapine is one heck of a lot better than from zolpidem (Ambien), and it doesn't cause the kooky (albeit enjoyable) hallucinatory/perceptional dream-like side-effects.

[Canuckistan Bob]

The association of early SSRI use and suicide, especially among young people, is well known, and actually, pretty well understood. It is almost a classic instance of correlation not implying causation.

You are depressed, and extremely suicidal. However, because of the depression, you are not really able to put two thoughts together in a row coherently, or even muster enough determination to follow one course of action for more than a couple of minutes, let alone simply get out of bed, so your suicidal tendencies are difficult to act on (not impossible, many many many severely depressed people are able to get it together enough to kill themselves).

You go on SSRIs, and a week or two later, you start feeling just a little teeny bit more able to hold a thought for a few minutes, and can even get yourself out of bed. To your excitement, you can actually hold a train of thought together for a few minutes. Yay, you can now get out of bed and kill yourself. And if you are not cared for, there is an increased chance that you just might.

If, however, you hang in there for a couple of more weeks, you actually start to feel rational and good enough about life that suicide no longer seems like such a great idea. It can take months or even years before most depressives take it right off the table, hell, many of us with perfectly normal serotonin levels never quite take it off the menu, but its imperative recedes to normal levels.

SSRIs take time, is all, they aren't instant cures out of a bottle. And they do not cause suicide, though it would be fair to say that they give you enough of an initial boost to enable suicide.

So no, the side effects of SSRIs do not really include suicide, that particular impulse was there all along. Side effects do, however, exist: most people on them can pretty much kiss their sex life goodbye. Most people, male and female alike, find orgasm while on SSRIs problematic. Not necessarily impossible, but problematic. There are no free lunches.

[Sehmket]

I know an anecdote is not data, but to share my story, I was put on an anti-depressant a few weeks ago. Within a week, my suicidal thoughts had stopped, and within another week, it was like my whole inner monologue had changed. I went from spending, oh, 50-75% of my time thinking about what I had done wrong and ways I had screwed up to thinking about... stuff. Work, dinner, my garden... normal things.

My life isn't perfect, and I have some issues to work through with a counceler ( I damn near destroyed my marriage while I was depressed, still not sure what's going to be the final result of that). But, the medication lets me think well enough to actually work on those issues. I've also had almost nothing in the way of side effects (If anything, my sex drive, which is one a lot of people complain about, is off the charts).

The weird thing is that my brain doesn't seem to know what to think about when it's not self-criticizing, so I end up with this endless stream of pop songs. It's hard to fall asleep because my mind is racing so fast. In the first two weeks, it was up to four songs at a time; now it's down to one or two.

[jezzaOZ]

I spent two or three years on anti-depressants - SNRI. I finally decided that they weren't much use so tapered off under medical supervision.

The weeks following the last minor dose were hell! I had to go into hospital twice for acute emotional attacks - despite me being pretty normal during the entire treatment.

I'm fully weaned now and generally I can say I am as depressed as during treatment but at least I'm drug free.