Dr. Mark Olfson, New York State Psychiatric Institute; Steven Marcus, University of Pennsylvania
Archives of General Psychiatry
Antidepressant use in the U.S. doubled from 1996 to 2005, according to a new report in the August issue of Archives of General Psychiatry. During that decade the last period in which data were available the percentage of Americans using antidepressants surged from less than 6% to more than 10%, or more than 27 million people. The study, which surveyed nearly 50,000 people above the age of six, reveals that antidepressants the most commonly prescribed class of medicine in the U.S. are being used to treat not just depression and anxiety but disorders ranging from back pain to sleeplessness. The authors also underline the degree to which pharmacology often supplants psychotherapy as the primary treatment for mental ailments.
1. On possible explanations for the pharmacological boom: "Several factors may have contributed to the increased use of antidepressant medications. Perhaps most important, major depression may have become more common ... [several antidepressants] were approved by the U.S. Food and Drug Administration to treat depressive and anxiety disorders ... [and] improving public attitudes toward seeking mental health in general, increasing rates of treatment in individuals with major depression, and growing public acceptance of a biological cause of depression may also have contributed to increasing antidepressant use."
2. On the comparatively low rate of antidepressant use among African Americans: "This is consistent with a broad recent trend toward increasing disparities between African Americans and non-Hispanic whites in mental-health-service use. More specifically, African Americans may be less predisposed than Hispanics or nonwhite Hispanics to use antidepressants. In a sample of primary-care patients with depression, African Americans ... reported a stronger preference for counseling over medication."
3. On how strategies for coping with disorders like depression are changing: "Among antidepressant users, the percentage who also received antipsychotic medications increased, whereas the percentage who also underwent psychotherapy declined. Together with an increase in the number of antidepressant prescriptions per antidepressant user, these broad trends suggest that antidepressant treatment is occurring within a clinic context that places greater emphasis on pharmacologic rather than psychologic dimensions of care."
Nearly every positive trend the study highlights is offset by a warning bell. As the amount of money spent on direct-to-consumer antidepressant ads skyrockets, the stigma attached to the products appears to be dissipating but more and more Americans are reporting symptoms of major depression. Access to drugs that can alleviate serious disorders is improving, but the doctors doling them out are working outside their areas of expertise about 80% of antidepressant patients are receiving care from someone other than a psychiatrist. "These trends vividly illustrate the extent to which antidepressant treatment has gained acceptance in the United States," the authors write. Problems that were once solved partly through hours of introspection on a shrink's couch are now considered curable with a simple pill. It's up to us to determine whether this represents a step forward or back.