Most People Use Antidepressants, not Therapy to Treat Depression

By Merely Me Wednesday, August 05, 2009

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There was a recent article in USA Today which cites some interesting statistics about the way Americans treat their depression. I am sure that many of you will not be surprised by the results.

The USA Today article presents the findings of a recent study led by Mark Olfson of Columbia Univeristy and the New York State Psychiatric Institute:

10% of Americans (27 million people) were using antidepressants in 2005 compared with half that number in 1996.
Half of those people studied were taking antidepressants for other conditions including back pain, nerve pain, fatigue, and sleep difficulties.
Psychiatry has taken a hit in the recent decade. Around 32 % of antidepressant users used to seek treatment from a psychiatrist. This has decreased to less than 20%. It seems that 80% of patients are getting treatment from doctors other than psychiatrists.
Monies used for antidepressant advertising has increased from $32 million to $122 million. That is quite a leap.
The percentage of children aged 5-17 using antidepressants was 1.4% in 1995 and this increased to 2.6% in 2005. In another study researchers are saying that they see evidence of depression in children as young as three years of age.

So we have all these numbers and statistics. What can we make of it all?

I am immediately reminded of a poem written by a friend of mine, Dr. C.E. Chaffin, entitled "The Glass Giraffe." I had done an interview with Doctor Chaffin some months ago which you may read here. Doctor Chaffin has Bipolar Disorder and writes poetry as one way to cope with having this potentially debilitating mood disorder. These lines of his poem have always resonated with me:

"Finally the antidepressants kicked in
and I felt like myself. When I left
you gave me another card
since therapy was "unfinished"
and I might be back
on your couch or another's.

I gazed at your office figurines,
crystal leopards and pewter trolls,
porcelain ballerinas and kachina dolls,
and imagined the souls of all your patients
trapped inside them-those, who like me,
sought relief through words
when only medicines would do.

I could have been the glass giraffe."

Clearly some people who suffer from mood disorders are greatly helped by taking antidepressants. There can be a very strong biological component to depression and science has discovered new ways to focus treatment on this biological aspect of mood disorder.

Yet it is seldom that simple as taking a pill to "cure" depression. Talk to anyone who suffers from depression and you will find that there are more causes for depression than there are treatments. Stress, childhood traumas, relationship problems and loss are but a few of the reasons one might lapse into a depressive episode. There may also be behavioral reasons such as learned helplessness and patterned reactions to stressful events which can cause depression. Cognitive issues also may play a part in depression as the way we think about things can directly affect our mood.

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Comments (25) | Add comment

rose martin

8/ 5/09 6:21pm

Hi Merely Me, very interesting reading ! When I was a young child, I now know I suffered bad depressions/low self esteem. The support systems werent in place, the knowledge they have today wasnt there. At 6 I was put on Sedation.I was trembling at night,scared. Couldnt swallow because Id developed a fear of choking and dying. What Im sayin is, The Therapies CBT Groups Counsellors in schools etc, didnt exist when I was growing up and the Depression became worse.

I am very worried that Doctors are using Anti-depressants as a FIRST LINE of treatment. As a Panacea, a cure all. For many people, coping ok, not having a disabling anxiety, or a severe Mood Disorder, a good Therapist, support Group is paramount. Everything now has to be immediate and Fast - from food to Cures. The pharmaceutical Ads in those Medical Times that Doctors and Psychiatrists receive usually have a heading 'Shes lost all joy and nothing seems to help' the idea being that the Antidepressant will cure that. This is Obscene. I feel life is very stressful for younger people in particular 20s and younger, the pressure to look thin, to be cool, in control, its not healthy and the Media ensures we buy into it, add to that family breakdown, a lack of true Values and any type of Spirituality and youve a recipe for great unhappiness... which I dont think respons to antidepressants. It reminds me of the 60s when as a young girl with aroraphobia and depression, I was put on Valium because the pharmaceutical companies said it was non addictive and 'cured' anxiety.

Im very worried that antidepressants are being doled out as a 1st line of treatment simply because, the support systems ARE there, internet is there now for people to try and learn and better their lives. I think the fact that so much is being spent on advertising is sad. IF I presented today, as a younger person with anxiety and depression I wouldnt take it as the first line of defense, again its about educating the public that SSRIs are the last alternative. I know I take them as I do medication to take down my anxiety levels. I do suffer Bipolar 2 but I realise I have to work on myself, everyday, pushing, learning, meditating, visualisation, helping others working on ways to make my life better. In giving antidepressants as a frontline therapy, its a disaster waiting to happen. I even heard recently of a couple who visited their doctor because hes very shy at parties and hates small talk. he was given Seroxat [Paxil] and his girlfriend is delighted that its made him and extrovert ! this is worrying.

Merely Me

8/ 5/09 6:33pm

Right...I agree. I think that they are over prescribed and...there seems to be little thought about the accuracy of a diagnosis or whether or not other things have been tried first. I think we have pathologized human feelings...including anger and sadness. When depression becomes disabling...you cannot function...you are in danger of hurting yourself or others...yeah...medication absolutely makes sense. Nobody should suffer needlessly.

Then again there is a train of thought out there that if depression is allowed to go unmedicated that it produces bad changes to the brain...that medication could have prevented. I am not sure about the science behind that theory but I have heard it.

I believe that there is no one answer for treating depression because there are multiple causes. I think it needs to be dealt with on an individual basis.

Good thoughts you have...thank you for sharing them here!

jpw2008

8/ 5/09 7:07pm

it's nice to be alive said the blind man to the deaf man,and then he fell down a well.Oh well!!

That was a deep subject that I can never touch..

Jon

Merely Me

8/ 6/09 7:51pm

Hi Jon!

It is good to see you. I sure hope you don't fall into a well!

Judy

8/ 5/09 11:27pm

I, too, think it's alarming that antidepressants are prescribed so quickly. One thing I have noticed is that it seems many people get them from their family doctor, someone other than a psychiatrist. I think that can be a problem, just because a general practice doctor usually doesn't have the vast knowledge of pharmaceuticals that a psychiatrist would. A psychiatrist might be more likely to tell a person to try therapy and to maybe even help you find someone. I think one of the problems we have, too, is that there aren't enough psychiatrists for the number of people who need them, probably not enough therapists, either. The wait for a psychiatrist if you are a new patient can be quite long. I know of a child psychiatrist that I consider to be incompetent who is still practicing because, I was told by the insurance company, that there is a severe shortage of child psychiatrists. Gee, that makes sense.

I do think that antidepressants are very useful for a lot of people and one benefit is that they can possibly help a person feel well enough to do the emotional and personal work they need to do to make changes in their lives. Sometimes you can get so depressed or anxious that you can't make reasonable decisions that are in your best interest. When you hear about them being prescribed for people who have things like social anxiety, it makes you wonder if people think everything in life is supposed to be easy and if it's not, you must need a pill.

As has been mentioned, it certainly is a complex issue and no definitive answer that fits everyone. I have heard that untreated depression has a greater chance of returning and that the more episodes you have that are untreated, the worse it gets. I'm one of those people who is afraid to stop taking mine because I've tried not taking it and it didn't work out. Maybe I will try again some day, but for now I think of it as treatment for a chronic disease that I don't want to become acute. I guess people should do whatever works for them, but I don't think we need the pharmaceutical companies hyping up their products and making people think they can make everyone feel better. I really wish they would outlaw it, truthfully, and remove the temptation to self-diagnose. Maybe they could spend the money on making better drugs with fewer side effects or lower their prices so they would be more affordable for those who really need them. And that is all I have to say right now!

Merely Me

8/ 6/09 8:03pm

Hi Judy!

Once again I find myself agreeing with what you are saying. It does seem as though there is a pill for anything and everything. I don't think a diagnosis means anything anymore. The last um..."therapist" I went to asked me what diagnosis I wanted and gave me some choices and he would write it down. Seriously.

And you have people diagnosing themselves on the internet. What really irritates me lately is the number of people saying that they have autism. My son has autism and it is a serious deal. Someone who is socially awkward can go on the internet and read a few things and declare themselves on the spectrum. The words lose their meaning.

I don't know when it happend that antidepressant ads appeared on TV but...I do feel like it is too much. It is like we want to eradicate all sadness. Sometimes it is appropriate to feel sad! You can't be happy all the time. But we have everyone thinking that they have depression. It is my opinion that mood disorders are entirely over diagnosed.

I will get off my soap box but these are but some of my thoughts...

fifi

8/ 6/09 2:46am

The thing that worries me , is that antidepressants can have serious side effects. I know from experience that paroxitine made me feel a hundred times worse and suicidal. I had to stop them quickly, but for many other people they work.

I think it's so important that people are supervised properly, not just handed out pills and thats it. They do help a lot , when you find the right ones and stick with them. I can only speak for myself and close family. They just lift you back up so that you can help yourself when you are feeling disabled with depression. I hate it when people say they are 'happy pills' they dont make you happy just able to function better. It's a pity that they dont prescribe outdoor clubs, like walking clubs or swimming clubs where people in the same situation can get together and socialise, or group exercise sessions with nutrition classes and a counsellor, so that people weren't isolated when going through this.

Merely Me

8/ 6/09 8:11pm

You make such good points Fifi!

Yeah the other ways to help depression are seldom talked about by professionals. At least in my experience.

What really irks me is that so many people are not told about these side effects or withdrawal symptoms by the doctors. That is why so many people are here and asking these questions. I need to preface this by saying *some* doctors don't tell us about the side effects and so forth. When I had some medical side effects to Prozac...I had a heck of a time getting any answers from the medical folk who prescribed me the medication. I think it is because...the doctors don't have time to really talk to us. They are over booked and over worked.

Thanks so much for sharing here...you add so much to our discussions!

LyraStorm

8/ 6/09 4:32am

Hi Merely Me, you're not alone in not taking anti-depressants. Currently I'm on a drug trial for an anti-oxidant but it's not an anti-depressant (I mean I can just stop taking it immediately at any time - I don't have to get weaned off, it's more of a supplement, like taking vitamins)... I don't think I like it, if I am even on it, and will not try to continue taking it after the trial is done. I have in the past tried a couple of anti-depressants but they didn't help me, only added extra symptoms for me to deal with.

I do know of some who have been helped a lot by medication, but I know of just as many who felt that medication failed them or in some cases made things worse. I believe you are right when you say it is subjective.

I hate that pharmacetical companies are just trying to sell their product and by doing so almost advertising depression - how many times have you spoken to someone who reckons they have suffered from depression when they haven't, they've just had a bad time at one point or another?!? And advertising anti-depressants only encourages people to think everyone knows what it is like and there is a quick fix. I don't see them advertising drugs for aids or cancer or any other such disease so why anti-depressants? It is quite insane... which I guess is appropriate for a disease in the mind, lol...

Merely Me

8/ 6/09 8:21pm

Yeah it is a tricky situation. I am very glad that we do have medications and for some people they are life savers. I do believe some people would not be here today if it were not for these antidepressants. And some people would never know what it is like to feel free of the weight of depression.

But I think it should not be the first thing doctors should recommend. And it should not be the only thing they recommend. I believe some balance is needed... I feel we are veering too far in one direction.

I would like to hear more about the antioxidant you are taking. Has it helped at all?

Thank you Lyra...as always...for sharing your experience and insights here.

Anonymous

8/ 6/09 5:36am

I like these comments very much. I agree with all of you here.

Merely Me

8/ 6/09 8:22pm

I am glad you are here Alfredo and partaking in this discussion.

Judy

8/ 6/09 10:49am

One other thing I'd like to add to what I already said and that is that there is an incentive for people to take medication rather than participate in therapy - insurance generally will cover medication better than it will cover psychotherapy. My insurance, for example, only pays 55% of the "allowed" amount for therapy because my therapist is not in the freakin' network since I've retired. Before I retired, it paid 75%. Anyway, that can be a big consideration for people who rely on insurance. Even for people who don't have it, it's probably easier to get free meds or samples than to find free or cheap therapy and then you probably don't get much of a choice.

Merely Me

8/ 6/09 8:25pm

Judy...you have probably said the true reason why people don't go to therapy...it is too expensive! Insurance doesn't cover it very well. I had a seven hundred dollar deductible before they would even pay anything and you are limited as to the number of sessions you can go to. Most therapists charge a hundred dollars or more for less than an hour of therapy...who can afford this nowadays?

We need more coverage for mental health.

Anonymous

8/ 6/09 12:14pm

Dear Merely,

I feel that it is important to talk about self fulfilling profecies here. For example, while we understand that medication can help in some cases a person may begin with the initial belief that the medication will not work. Alternatively, like the Doctor who wrote the poem in your post, one believes that Cognitive Therapy will not work. While this may be the case, it may also be that once a person makes up her or his mind that Cognitive Therapy or medication will not work this is what will happen in reality. The mind works in misterious ways. Experiments have shown that people who are under hypnosis, when are told that their arm is being burned by a lit cigarette, a cigarette, they develop real blisters even though there is no cigarette. Our mind can fool us to believe and experience reality, sensations and feelings that are very real. THis is due to beliefs that turn into self fulfilling profecies. If I strongly believe that a medication will not help me then in all probability that medication will not help. If I believe that Cognitive Therapy will not help me, than in all probability it will not. Self fulfilling profecies. What do we do about this phenomena? As you know some people are hypnotised very easily. They have shows on TV and while this seems magic it is not really. Many people can be easily hypnotised and will do anything the hypnotists suggests to them. In an experiments a person was hypnotised and, and while under hypnosys, was told that from now on he will no longer suffer from depressio that when any feeling of depression came the person had to laugh about it and begin to feel better after the laugh. Well, that particular person no longer suffers from depression. I do not know how true this is but I know that they are conducting some experiments with hypnosis. I see if I can find that research somewhere. I have thousands of research papers on my computer I just have to dig it out. In Australia for example, another new research follows the idea that Depression and Bipolar II have to be understood holistically and that Cognitive Therapy, in most cases, is very important for these conditions. What they are doing is asking a person like your Doctor who believes that Cognitive Therapy does not work. With permission they put the person under hypnosys and then go about doing some Cognitive Therapy. If the therapy works under hypnosys the patient was being misled by his or her self fulfilling profecies and her or his mind was preventing the Cognitive Therapy from working. But under hypnosys they have no control so this goes to the truth of the matter overpassing the personal belief of that person.

Judy

8/ 6/09 5:06pm

Hello, Alfredo. I wanted to say something about hypnosis, as I understand it. I have been working with it, off and on, for many years and from the start, was told that a person will never do anything under hypnosis that goes against their belief system, so it makes me wonder about these stunts you see on TV - I am suspicious about them being "plants." I have been under hypnosis hundreds of times and I really don't believe I could have been made to believe something that I did not feel was really true; any physical effects of the hypnosis were totally due to my own memory, not anybody suggesting something to me. Anyway, I'm not arguing with you, but just relating my experience of it. I have always done it in a clinical setting (except when I've done self-hypnosis by myself) with a person who was a professional and very experienced with using it. I've also heard that in real hypnosis, you DO remember the experience and what went on during it. That has been the case for me.

Anonymous

8/ 6/09 5:58pm

yes it is absolutely true. Some people can be hypnotised easily but I am not one. Nothing hypnotises me. If you are lucky enough to be easily hypnotised then a person could simply suggest to you that you will benefit from Cognitive Therapy, for example, and find that it really helps you even though you previously did not believe in it. Then,when you wake up chances are that Cognitive Therapy will indeed help you. Either you are a person who can be easily hypnotised or you are not. It sounds as if you are not one of these people and this is good for people who can easily be hypnotised will do almost anything they are told. It is something known to be a fact even by health professionals.

Judy

8/ 6/09 6:38pm

Interesting.....I've been told that I'm a good hypnosis subject, most likely due to my history of dissociation. I guess it's another instance of different opinions by different authorities.

Merely Me

8/ 6/09 8:35pm

Alfredo...this is a very interesting perspective. There is some truth to what you are saying...that is why some people respond to placebos.

However...sometimes the self fullfilling prophecy has nothing to do with effectiveness of a treatment. Take the case of my son who has autism and does not understand such things. He used to cry for no external reason. He was suffering. With Prozac...he is much happier. He cries when he is sad but he doesn't have the meldown's and crying jags which used to last for hours. It has nothing to do with what he believed...it had to do with...this medication helped him.

Nothing is 100 percent certain. We can come up with many theories and then poke holes in them all. Nothing is absolute.

Anonymous

8/ 7/09 1:06am

Dear Judy,

I am not sure if we are talking about the same thing. Some people get into a state of deep hypnosis simple when another person sneps the finger with a suggestion to go into a trance. It is as simple as that. From what you tell me I doubt that you are this sensitive to suggestions to become deeply hypnotised to a pint where you follow commands without questioning. Some people are easily put into a trance but others not. It is just the way it is. There is no magic about it.

Anonymous

8/ 7/09 1:30am

Dear Merely,

your son could not suffer from a self fulfilling profecy because as you say he has autism and he is not aware of issues to do with medication, mental illness or cognitive therapy. For this reason he could not engage in a self fulfilling profecy. I agree that one theory cannot work 100%. I was not talking in absolutes. But when an experienced doctors tells us that Cognitive Therapy does not help him at all I may think that it is because he is a doctor and he has been conditioned by the academic thinking of his medical establishment based on the biological nature of mental illness, medication as the only way to help oneself and so on. As you know no one can submit an academic paper on mental illness which criticises pharmaceutical companies. Mine was regected by my University and I am pretty sure that pharmaceutical companies have a hold not only on doctors and the medical profession but on Universities, research, publications and so on. Put iot bluntly if you want to be a working research fellow in the area of mental illness you better favour the ideas of the pharmaceutical companies. Now I can be forgiven for thinking this way. If I was to study in such a medical environment where mental illness is purely biological, where people who suffer from bipolar are time bombs waiting to explode unless they medicated themselves with dangerous cocktails of drugs and so on I too would think liek doctors. Fortunately I do not and probably never will. But yes I agree that there is no one theory and mental illness is complex.

Judy

8/ 7/09 10:16am

Alfredo, I have never heard of anyone going into an instant trance with the snap of fingers. That sounds like something that would happen if someone were given the suggestion, under hypnosis, that they could enter that state again with the snap of fingers. The hypnosis I'm talking about involves a slow descent into total relaxation where you are unaware of other things going on in the room and your mind is relaxed enough to be able to focus on anything, such as lost memory. You can also follow suggestions - if you wish to. This also involves a certain amount of trust in the person who is conducting the hypnosis. I am going to do some more reading about this. Thank you.

Craig

4/ 2/10 4:48pm

The doctor in question never claimed CBT wasn't helpful--only in his own case. See post below.

Craig

4/ 2/10 4:39pm

Good article, Merely, and kudos to you for not taking medications.

I like to think there are three kinds of depression.

The first is the normal "blues" that affect us all and may be triggered by circumstances we ought to change or need to accept.

The second is clinical depression brought on by circumstances that takes on a life of its own even when those circumstances have changed.

The third is pure depression, most often seen in the manic-depressive, not related to circumstances at all, almost purely a chemical phenomenon that only responds to medications or electroconvulsive therapy.

The first two types are far more common. I suffer from the third type. If there were a therapy to help me more than my own attempts to stay occupied, I would embrace it, but no talk therapy has helped me in 25 years, so I stand by my experience.

C. E. Chaffin

Merely Me

4/ 2/10 4:50pm

Heyyy

It is really good to hear from you!

Depression is complex isn't it?

I applaud you for voicing your opinion and for talking about your experience. Being on this site has really taught me that depression can be so biological. Meds do help so many people.

It is all about finding what works for you.

Thanks so much for writing here. I hope you continue to share.

Most People Use Antidepressants, not Therapy to Treat Depression

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