Depression – An Over-Medicated Nation

In 2010:

  • one in five adult Americans were taking some kind of drug for emotional issues
  • one in ten adults were taking anti-depressants
  • Americans spent more than $11 billion on anti-depressants
  • prescriptions for  “psychotropic medications” had increased 22% from 2001 to 2010.
  • (the above figures are from  the CDC and APA Monitor, June, 12012. page 37.)

Four out of five prescriptions for emotional problems are written by physicians who are not psychiatrists (Psychiatric Services, 2009).

Sadly, general practitioners and family doctors completely miss the diagnosis of depression for about half of their depressed patients.

Also, fewer of their patients receive psychotherapy than in the past.  In 1996, 33% of depressed patients received psychotherapy, but by 2005 only 20% of patients received psychotherapy (Archives of General Psychiatry, 2009).  This has happened even though excellent long-term research finds that psychotherapy is superior to medication for most cases of depression. (Hollon, in Archives of General Psychiatry, 2005).

The quickest-acting biological interventions for depression are often:

  • moderate exercise like walking
  • diet – reducing junk food, sugars, and generally eating more mindfully
  • getting better sleep, which often happens with a better exercise routine

While very helpful, unfortunately these interventions are often not enough to banish depression.

Research on anti-depressant medication has found:pills

  • anti-depressant medications are often helpful in relieving severe depression, but not so useful in mild and moderate depression.
  •  One family of anti-depressants – the SSRIs –  are most often prescribed, but an analysis of four FDA clinical trials of SSRI antidepressants found the drugs didn’t preform significantly better than placebos for mild to moderate depression, and the effects were small even for severely depressed patients (Irving Kirsh of Harvard, in PLoS Medicine, 2008).
  • medication frequently is not necessary to resolve depression at all.
  • Talk therapy can be as effective as medications when it comes to changing the neurotransmitters which research finds are associated with depression (e.g., serotonin, and dopamine)
  • medication without psychotherapy often leads to latter a recurrence of the depression.
  • psychotherapy in combination with medication is often best.

Anti-depressant medication can be especially useful as a boost when depression is severe, for instance if:

  • you have lost your appetite
  • you are not sleeping
  • you have lost all pleasure in life
  • you have no energy
  • you are unable to concentrate

Medications are also helpful for bipolar disorder. Bi-polar disorder involves moods swings between feeling highly energized (manic) and depressed.

Anti-Depressants often have the following complications:

  • reduced sexual energy, desire or ability
  • dry mouth
  • usually are recommended for up to three years before stopping “so that the new habits of living take root.”
  • do not magically change personality
  • can not teach coping skills and problem-solving skills that will stop you from getting depressed once you stop the medications

Research has found that depressed people who take medication without psychotherapy are more likely to relapse into a depressed state as soon as the medication is stopped.

While anti-depressant medications can sometimes help you to think more clearly to solve the problems that are making you depressed, research finds that those on anti-depressant medication do better if they are ALSO in psychotherapy.

Extremely severe depression is sometimes treated with ECT (electro-convulsive shock). This is rare. Usually patients who receive ECT have not responded to all other forms of treatment, and have been hospitalized for a considerable time before EFCT is used.

For very severe depression, new research protocols are being developed which involve the permanent implantation of electrodes in the brain. The electrodes give off very minute pulses of electricity that do not seem to interfere with memory the way ECT often does. These protocols, which in early studies appear to work at least as well as ECT, are not yet available outside of research programs.

More drug facts:

  • Americans spent more than $16 billion on anti-psychotics, and more than $7 billion to treat hyperactivity , ADHD  CDC and APA Monitor, June, 12012. page 37)
  • More than half of anti-psychotic medications were given to populations or for conditions when there was uncertain scientific evidence indicating their use (Pharmacoepidemiology and Drug Safety, 2011).
  • Anti-psychotics are often given to foster care children and elderly nursing home residents. In 2007, one in seven elderly nursing home residents had Medicare claims for anti-pyschotics, and 83% of those were “off-label” (USDHHS, 2007.)
  • A 2008 study found that 8,000,000 American children were on one or more psychotropic medications, but their diagnosis is often unclear.  We have no good studies on the long-term effects of giving psychotropic medications to children  (Journal of Child and Adolescent Psychiatry and Mental Health, 2008)
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