Is America over-medicating itself?

Great Debates
1

Caveat: If you’ve come here to make an argument about depression being a disease, please back it up with some facts or literature that backs up your claim. Any bleeding-heart appeals to emotion will be steadfastly ignored.

That said, here’s a little background on me: I’ve worked in the medical field for almost 10 years now, mostly in radiology. I am not a doctor (but I play one on TV, HAR!).

It has come to my attention recently that almost every single one of my patients is on some type of (sorry if I’m using the wrong terminology here)anti-depressant medication. If I was forced to pick a number, I’d say that about 85% of my patients are on at least one of the following medications: Zoloft, prozac, wellbutrin, clozapine, paxil, celexa… Hmmm, that’s all I can think of off the top of my head. Anyway, is it really possible that eighty-five percent of the population is depressed? Granted, my sample comes from a cardiology clinic which has mostly elderly patients, but even if you were to attribute 35% of that to error on my estimate and sample, that still leaves 50%. I don’t think my number is too far off though, really. Perhaps we’ll get someone more knowledgable on the subject to give us some better numbers.

Even if it were 50%, I just have a hard time classifying so many people as depressed, etc. And if they ARE depressed, well, wouldn’t that make it NORMAL to be depressed? Is it right to medicate half of the country for this? Why medicate a normal state of being? One of the arguments goes like this: “If 50% of the population had diabetes, wouldn’t you medicate THEM?” And my answer would be, of course, “Yes!” But, and this may well end up in a pit thread entitled, “Demo, you sack of shit, depression is a DISEASE!”, I am still not totally convinced that it IS a disease and even IF it is, that we should be medicating these people instead of letting them “deal with it”.

So, have at it. What percent of people do you think are actually suffering from “clinical depression”? What percent of those people do you think we should be medicating, if any? Is depression really a disease or is depression just a natural mental state for us? Even if it IS a disease, should we be medicating people for it, or are we doing more harm than good with the medications?

Thanks.

2

I don’t have a citation handy, but I think the diagnosis rate for depression in the elderly is below 10% overall. However, depression is thought to be more likely when the person is also suffering from a debilitating disease, which may be the population you’re seeing.

I know that my Dad was put on Prozac for at least a while when my mother was diagnosed with breast cancer. He has diabetes and emotional stress makes it very hard to regulate.

3

Did you do any research at all before posting this? There are a variety of sources of depression, and a number of them are clearly physical in nature. See the linked article in Scientific American. It can perhaps be debated what has caused depression not linked to objective physical causes, but I don’t think those person are any less worth of relief.

BTW, Depression ranges from 12-15% of the population at any given time by most estimates (women generally being more susceptible than men), though rate does climb with age. Of these most (approx. 80%) respond to treatment. I’m of the opinion that some persons are misdiagnosed, but the greater good is served by taking this condition seriously.

4

otoh depression is a lot different from diabetes. Diabetes doesn’t go away when you quit your piece-of-shit job.

I know little about clinical depression, probably about as much as most radiologists. Although I do think that many people are judged to be chemically depressed when they’re actually environmentally depressed - there is some sort of factor in their surrounding life that causes bouts of depression, and would probably require therapy, not pills.

5

Are we overmedicated? Yes.

Are antidepressants inherently bad? No.

Is depression a disease? According to some.

Is major depression something to worry about? Yup.

Chronic low depression? Yup again.

If lots of people are depressed, even if it’s not a disease (whatever definition of that we’re using), does that mean they should just suck it up? Nope, nope, nope.

Sure, there are be plenty of people on drugs who ahould not be, or who should only be on drugs as part of a comprehensive therapy plan and are not.

But can you show me any reason that we’d be better off, as individuals or a society, without antidepressants?

6

Actually, Demo, given the well-documented relationship between serotonin and other neurotransmitter levels and depression in the medical literature, I think it’s incumbent on you to support your thesis by establishing that depression is not a disease.

7

No, other than reading random magazine articles, medical journal entries, seeing TV shows and my own observations. Oh yeah, and a intro to psych class about 3 years ago. But I haven’t done any specific research into the matter. Thanks for the link to the article, I’ll read it when I get a few minutes. Thanks for the quote, too, although it looks like the typical, open-ended, mumbo-jumbo response I normally see from the “disease” camp. I’d be more interested in seeing something like, “In 80% of the subjects diagnosed with clinical depression, MRI scans showed a higher concentration of blood flow(or seratonin, or butt-juice, or whatever theoretically causes depression) to the right hemisphere of the brain when compared to the control patients”. Or something like that. You know, concrete evidence. Not just someone telling me that’s the way it is. Maybe that article has what I’m looking for.
Wow, I’m really surprised the numbers are so low for depression. I wonder if the numbers are higher for California. :wink:

8

GQ aside, if you please?

What are the baseline seratonin and other levels for a non-depressed person, and what is the deviance level from that baseline at which one is considered medically depressed?

For what percentage of patients on anti-depressant medication are levels actually taken, as opposed to those who receive prescriptions on self-described symptoms or observed behavior alone?

I’ve read enough that I really have no doubts that depression is a medical disease with an appropriate pharmacological treatment regimen. But I haven’t read enough to know that Americans are not also overmedicated, and the sheer size of the industry scares the crap out of me. So any of my ignorance that you can eradicate I’d certainly appreciate.

9

Well it could be that America has realized that it doesn’t necessarily need to be in the level of oppression that is considered the modern work ethic. We have the technology available to consume a little less, work a little less and have A LOT more free time, but, we choose not to, because that’s <gasp> lazy. Everyone laughs at those silly puritans and then at least pretends or tells other people that they are living up to that ideal. We are a nation of liars and hypocrites, living toward an ideal that most of us don’t want enough to attain. Because in this country, there is really no reason for you to not be able to taste wealth if you want it bad enough. The American dream is a farce and is one of the most ridiculous ideal that’s ever been upheld. Spend your life buying your house, your car and your 1.75 kids, for what? So you can come home in your Lexus exhausted to give each kid 20 bucks so they’ll leave you alone so you can pass out exhausted to help finish out your 60 hour week working toward a goal that accomplishes nothing but help other people and you afford lexii?

That is why so many people are medicated for depression in this country.

Erek

10

Good point, manny.

As a matter of fact, something that caught my eye while reading the article Waverly submitted was this:

That just doesn’t sit well with me.

Phil, you’re right. And, as that discussion would require way more time for research than I have right now, may I be allowed to drop the question of whether depression is a disease and go back to the question of whether or not we are over-medicating people? Let’s say, for now, that I concede that certain types of depression are, indeed, a disease.

11

I would say its simply because they can. As I recall from my one anti depressant I took the doctor thought that I wasn’t depressed. Even if depression is a disease I doubt anti depressants do more than sugar water 90% of the time.

12

Here’s an article illustrating the link between serotonin levels and depression. Unfortunately it appears that the measurements were done post mortem or though a spinal tap. So, while this establishes the link, it also makes it clear that most patients are not diagnosed using a direct objective method. Instead, diagnosis seems to depend on establishing a relationship between the symptoms and the serotonin levels found in the research. Since regulating serotonin, as stated earlier, has an 80% rate of effectiveness, it seem relatively safe to assume that the relationship holds true with about a 20% margin of error.

13

Um, rather than ask you for a cite or support for your statement, I will merely point out that if you’re interested in reading about the pharmacology of SSRIs and their performance in placebo-controlled studies, you can find that information here for Venlafaxine, here for Paroxetine, here for Fluoxetine, and here for Amitriptyline. Those are among the most commonly prescribed SSRIs.
Also, I don’t disagree with Demo’s thesis that depression is quite probably overmedicated; but I think it’s important to distinguish between “depression” in the everyday “ho-hum, I’m blue” sense, and “depression” in the “I’ve lost interest in all my hobbies, have no libido, rarely eat and miss at least one day of work per week” mental health sense.
Given the degree to which diagnosis relies on self-reporting, it’s inevitable that there will be some overmedication. And even if it isn’t a disease according to the classic model, there’s little doubt that the kind of depression we’re discussing is a disorder, and a severely mood-altering one at that.

14

While not having any cites to back up my admittedly personal observations, I think that a lot of people who are so depressed arrive at their condition through paths largely of their own making. While there is a body of evidence to indicate a physical pathology involved in some forms of depression, many depressed people seem to be more willing to accept medication than to make lifestyle changes or concerted efforts to alter their behavioral patterns in such a fashion as to ameliorate their symptoms. The tendency for clinicians to overprescribe any of the huge variety of currently available crop of nuerotransmitter modifying drugs available is reprehensible. The efficacy of convention theraputic psychiatry clearly demonstrates that mere human contact has substantial curative benefits that are simply not provided by common mode medication.

The willingness of so many people to accept the use of powerful and relatively untested brain chemistry altering drugs smacks of taking the easy way out. It is similar to the recent spate of fat substitutes that allow people on diets to retain the sensation of eating fatty foods without curtailing their eating habits in a truly healthy fashion. So it is with what seems to be a majority of people who hastily resort to medication as a cure-all for their mental woes. Albeit, there is a certain population of patients who directly and justifiably benefit from the use reuptake inhibitors and the like, these few are far outweighed by an ever increasing group of people who see the use of these profoundly influential drugs as a simple solution to their mental miseries.

I firmly believe that many people’s symptoms can be alleviated through self discipline in how one leads one’s life. Purposeful nurturing of strong friendships with people who are able to share in genuine introspection and analytical reflection can have a much deeper and healthful effect on one’s life than whole handfuls of pills. Far too many modern people are either unwilling or too lazy to expend the energy it requires to maintain these admittedly time consuming relationships. They wonder why they continue to spiral ever deeper into depression and sadness. There is no great mystery here, only a society where the quick fix (so to speak) is increasingly sought at the expense of community and friendship.

However depressed I might become, I cannot imagine playing the human Guinea pig in order to determine the long term effects of these insanely powerful drugs. Doctors, in their pursuit of less expensive alternatives to costly psychiatric therapy, are playing havoc with the minds of generations of our society’s population. We are becoming increasingly dependent on chemical solutions to mental illness without full consideration of the ramifications that these shortcuts pose. I liken this to the recent overuse of anti-bacterial cleansers and such. An epidemic of asthma has resulted from children being raised in such sterile surroundings. We are artificially imbalancing our environment (and brain chemistries) in an attempt to circumvent normal natural mechanisms.

In a similar fashion, many people seek to avoid the complexities of maintaining personal friendships and all of their time consuming and extremely healthy activities by, instead, gulping down a chemical panacea that is entirely unsuitable as a long term solution. Yet, people continue to think that sidestepping such time honored methods of sustaining mental and emotional health is perfectly acceptable. We had better hope that the long term effects of these neurotransmitter modifying drugs don’t come home to roost in psychotic episodes or worse.

15

As a grad-student working on my PhD in clinical psychology I figured I throw my 2 cents in:

1.) There is no diagnosis of “clinical depression”. There is Major Depression and dysthymia. Clinical depression just sounds serious, which is why folks use it.

2.) The link between serotonin and depression is NOT well documented as some people assume. It is more theoretical. there are some empirical studies (particularly post-mortem studies) which point to a link. However the effect size of such studies are typically tiny, around 2-4%, which ain’t much in the grand scheme of things. Given the “file drawer effect” we can reasonably assume there are many studies which do NOT point to a link with serotonin which have never bothered to be published. Other medical conditions such as hypothyroidism or a mononucleosis infection can certain bring on symptoms of depression, but most cases of depression are probably not chemical in origin.

3.) SSRI’s do not work particularly well. Someone said they are 80% effective, which is completely untrue. Most effectiveness studies put their overall effectiveness at around 33%, which is just a smidge over the 30% effectiveness for placebos. I invite those who are curious to look up the Irvin and Lynn (1999) article published in American Psychologist. Further a NIMH supported study by Elken et al (1989 I think?) pointed out that SSRIs are no more effective than therapy of any kind. Other research suggests that talking to your bartender, priest or hairdresser is just as effective as taking Prozac, Effexor, Paxil, Elavil, Welbutrin or whatever you may be on. Some of the studies which trumpet the effectiveness of drugs are also funded by drug companies, which needless to say should be held in suspicion.

4.) For those who are curious there is no convincing evidence in the whole wide world that social anxiety is a medical problem or that Zoloft in any way helps social anxiety. But I diverge…

So yeah, we’re overmedicated, but that is because people like the “easy-fix” for their problems.

16

Well, I guess I stand corrected. Thanks for the info, avalongod.

17

As a side note, I worry that this trend to medicate to “fix” mental issues won’t extend itself to clumsiness, forgetfulness, laziness…

…and then other things that society starts to think are not beneficial such as childishness, bubbliness, curmudgeonliness, etc.

It’s not beyond the realm of possibility that we will find that certain chemicals in certain parts of the brain cause us to be more or less like those terms, and by regulating them…

Do we come to a point somewhere where all of our personiality quirks are due to some chemical being somewhere in greater or less quantity than usual?

PeeQueue

18

The article I found [above] didn’t provide it’s numbers, would the 2-4% apply to the results they cite? Who is to say that such a seemingly small deviation is not, in fact, quite significant? A responsible researcher would conduct a test of statistical significance on any deviation. Unless you can cite something contradictory, can we assume that these researchers did just that?

From the National Institute of Mental Health [also cited above]: “One of the most challenging problems in depression research and clinical practice is refractory – hard to treat – depression. While approximately 80 percent of people with depression respond very positively to treatment, a significant number of individuals remain treatment refractory. Even among treatment responders, many do not have complete or lasting improvement, and adverse side effects are common. Thus, an important goal of NIMH research is to advance the development of more effective treatments for depression – especially treatment-refractory depression – that also have fewer side effects than currently available treatments.”

While 80% is not “completely untrue”, your numbers may be a measure of what the NIMH hints at, specifically they say that improvement may not be “complete or lasting”. Again, since you use objective numbers, I assume they have a source and a cite would be helpful.

19

I think the answer to the OP is “Yes”, hugely.

I believe that a large part of the problem is the direct advertising of pharmaceuticals to the general public, who are then advised to “ask your doctor about SOMA”, or whatever. I am nauseated by those commercials showing a person going to a job interview or staff meeting feeling panicked. You’re supposed to feel scared. It’s normal. Nobody lives their life down the median/mode line, and a operant person wouldn’t choose to.

That being said, I have taken SSRI’s for the last seven years. They seem to be working for me. They allow me to do the everyday stuff that everyone takes for granted. I shower. I leave the house. I talk to people. Pretty heady stuff if you have been without it for a while.

Depression isn’t having “the mulligrubs”, “being blue”, “feeling out of sorts”. Everybody feels that way from time to time, and for some maybe most of the time. For them medication probably won’t help. Anti-depressants aren’t “happy pills” despite what the pharmaceutical companies would have us believe. They are reasonable drugs for people with a big problem, and for them I am grateful.

Carry on.

20

Thanks for those links, Waverly.

avalongod, something doesn’t seem right. I’m ready to believe that MOAIs and the like are overprescribed, and maybe ready to be convinced that they are vastly overprescribed, but man!

Even if I believed in a massive conspiracy by pharmaceutical companies (not wholly impossible) and massive government incompetence (check my other posts in this forum – that’s a no-brainer!), I find it hard to believe that the same HMO that didn’t want to cover a trip to the emergency room for a heart attack (mine) will happily cover billions of dollars worth of pills that don’t work and which attack a chemical imbalance which is poorly associated with the disease in the first place. What’s the disconnect here that I’m missing?