If you do a search of the questions we receive on MyDepressionConnection you will find that the number one inquiry is about the topic of antidepressant medications. It is no wonder that this is such a popular topic as it is the most utilized treatment for depression. In fact, more Americans are using prescription drugs to treat their depression than talk therapy. A study published in the Archives of General Psychiatry, reported that in 2005 approximately 10% of Americans or 27 million people were taking antidepressants. This rate was double the amount from 1996. Yet the percentage of antidepressant users who also received psychotherapy plummeted from 31.5% to less than 20%. In addition, a significant majority of patients (80%) are being prescribed antidepressants from doctors other than psychiatrists. The growing popularity of using prescription medication to treat depression leaves many questions. How did this trend happen? How are doctors and patients making this decision to use medication as the primary treatment for depression and in some cases the only treatment? In this post we are going to take a look at research to find our answers.
What is causing this dramatic increase in antidepressant usage?
One would hope that more people are being prescribed antidepressants because there are better diagnostic procedures to identify depression early on. Another optimistic view is that there is less stigma associated with having a mood disorder and patients are more willing to consider treatment. Yet these reasons probably play only a very small part in this growing trend. Here are some of the more plausible causes for the great increase in antidepressant use in the past decade:
• Pharmaceutical Advertising
This huge increase in the number of people taking antidepressants comes as no surprise when you understand how much time and money is invested in pharmaceutical advertising. In 1997 the US Food and Drug Administration released new guidelines which allowed for direct-to-consumer advertising. This is why you see all those antidepressant commercials on TV. Do these ads have any impact on patients and consumers? They sure do. According to a report published in The American Journal of Medicine a 2002 FDA survey found that 43% of respondents reacted to a drug advertisement by looking for more information about that drug. We are now, more than ever before, making specific medication requests from our doctors. And much of this is based upon advertising.
Here are some sobering statistics to bear in mind. This same report in The American Journal of Medicine states that: “Between 1996 and 2003, there was a 400% increase in spending on direct-to-consumer advertising from 791 million to $3.2 billion. In addition, a 2008 a study found a huge discrepancy between pharma reports of marketing expenditures and what independent analysis has found. The study authors found that pharmaceutical companies spend almost twice as much on promotion as they do on research and development. You can read the details of this study, “The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States" in the January 3, 2008 issue of PLoS Medicine, an online journal published by the Public Library of Science.
The bottom line is that we are exposed to pharmaceutical ads every day through many different mediums. And the advertising is working. We are using prescription medications, including antidepressants, more than ever before. Whether or not this is a good or bad thing is left to you, the reader, to judge.
• Antidepressants are being prescribed to people who are not clinically depressed
One of the other proposed reasons for the surge in people taking antidepressants is that these drugs are being prescribed to people for other reasons than depression. In addition, many of the people who take antidepressant medication do not meet the criteria for clinical depression. A USA Today news report cited a study published in the Archives of General Psychiatry which showed that the majority of Americans who took antidepressants in 2005 were not being treated for depression. Other ailments such as back pain, nerve pain, fatigue, and sleep difficulties were often given as the reason for the prescription.
Early this year Reuters Health reported on recent research which shows that more than a quarter of Americans taking antidepressants have never been diagnosed with depression or an anxiety disorder. The original study was published in a 2011 issue of the Journal of Clinical Psychiatry in which the study authors concluded: “These results suggest that antidepressant use among individuals without psychiatric diagnoses is common in the United States and is typically motivated by other indicators of need.”
In 2006 Ashley Pettus wrote an intriguing article for Harvard Magazine exploring the implications of allowing pharmaceutical companies and insurers to “define the boundary between illness and health.” She discusses the paradox that although psychopharmaceutical sales have increased exponentially over the past two decades, only half of those patients with severe mental disorders receive adequate treatment. This author also points out that of the millions of Americans who take psychotropic medications; many are taking them for relatively mild conditions. Pettus gives her theory as to why medication is used as a first-line treatment for mental health disorders including depression:
“It’s clear that aggressive pharmaceutical marketing in combination with cost-cutting care has led to increased reliance on psychotropic drugs to the exclusion of other forms of treatment.”
• Antidepressants are a cheaper form of treatment than psychotherapy
In a previous post I asked the question, “Is Talk Therapy Dead?” Many people would answer yes to this question. Many psychiatrists are not offering talk therapy because it doesn’t pay. The current trend for psychiatrists is to provide brief consultation visits for 15-minutes or less for their patients. This way they can make $150 for seeing three patients for 15-minutes each as opposed to less than $100 for one patient within the hour. The bottom line is that the insurance companies are dictating the treatment options you will most likely receive if you visit a psychiatrist. Let’s face it. You can buy a whole lot of Prozac for the same money you would spend on an hour of psychotherapy. In the end, the therapy may be more effective in the long run for some patients, but medications are cheaper.
If it seems illogical to think that a psychiatrist could ascertain the medication cocktail appropriate for your mental health issues within fifteen minutes, consider the fact that most people aren’t even getting this level of expertise. The managed-care system has pushed primary care doctors, with little to no psychiatric training, into treating patients who present with mental health problems. The treatment almost always entails prescribing psychotropic drugs. A 2010 Consumer Report survey found that 78% of respondents got medication for their anxiety or depression from a primary-care physician.
Although cognitive-behavioral therapy has been proven to be an effective treatment for depression, most patients are offered antidepressants. If therapy is offered it is usually for a short duration as insurance companies put a cap on how many sessions will be reimbursed. The other problem is that talk therapies do not have the advertising campaigns or huge purses of money to promote them as do pharmaceutical drugs.
• In 2005 the Centers for Disease Control and Prevention (CDC) found that antidepressants are the most commonly prescribed drug in the U.S. Antidepressants are more prescribed than medications for blood pressure, asthma, or headaches. (Source: CNN Health)
• In 2009 antipsychotics were the top-selling class of medications in the U.S., with sales of $14.6 billion. (Source: IMS Health)
• Despite the recession an increase in sales of antidepressants and anti-cancer therapies helped to boost pharmaceutical revenue to over $300 billion in 2009. One of the antidepressants named as aiding in this increase of revenue is the highly commercialized Cymbalta. (Source: IMS Health)
• While pharmaceutical companies are increasing their revenues due to antidepressant and psychotropic drug sales by the billions, the majority of people with a serious mental illness are not getting adequate psychiatric treatment or care. Ronald Kessler, professor of health care policy at Harvard Medical School’s Department of Health Care policy led a study which found that the United States has a higher prevalence and lower treatment rate of serious mental illness when compared to other developed countries. According to Kessler’s study, approximately 60% of patients with serious mental disorders received no treatment between 2000-2003. Who did receive treatment? Nearly half of the people who actually received treatment did not meet the diagnostic criteria for a mental disorder. In other words, the people who needed mental health treatment the least got it and the people who needed it the most were out of luck.
In conclusion I have to ask, “What’s wrong with this picture?”
We would like to hear from you now. What do you believe are the primary reasons for the great increase in the use of antidepressants to treat depression? Do you think that a change in the way we deliver mental health treatment is necessary? Please share your thoughts and opinions with us.
Published On: July 18, 2011