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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Tuesday, March 28, 2006

    Sad Culture: Anti-depressant use is on the wane:

    By 2004, nearly 150 million U.S. prescriptions were written for the drugs, and they represented the third-largest selling class of medicines after cholesterol and ulcer drugs.

    But last year, U.S. sales of these medications, while still sixth in the leading classes of therapeutic drugs, dropped sharply, according to IMS Health Inc. a Fairfield, Conn.-based tracker of prescription drug data. And prescriptions for patients 18 and younger have plunged by 20% since 2004 when the suicide issue was raised at FDA hearings, according to NDC Health Corp., an Atlanta healthcare information provider.

    Having once practiced in a town where all the children were on Ritalin and all the adults on Prozac, this comes as welcome news. I worry about the future of a nation which attempts to medicate away every problem rather than facing them.

    As the article points out, many people find the anti-depressants aren't the panacea they thought they expected them to be. Of course they aren't. Life still happens to you whether or not you're on an anti-depressant. And sadly, many people in this country (and I suspect other Western nations as well) take these things for sadness, not depression.

    But the psychiatrists interviewed in the article seem to think we still aren't treating enough. They would urge double-depressants in many cases:

    "Most depression is treated in primary care. And while they do a good job with a lot of things, they often don't follow up as well as psychiatrists do," says Dr. Thomas Schwartz, a professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y. "Part of our job is to come up with alternatives for our patients. Often we end up adding medications so they work together."

    I would be more than happy to send every sad patient who wants an anti-depressant to the psychiatrist - if I could find enough psychiatrists to see them. Bet if they had to see everyone who sought an anti-depressant, they'd quick stiffen up the diagnostic criteria for depression. No more drugs for "seasonal affective disorder" or "social anxiety" or "PMS." They'd just be told to deal with it.

    This is one of the reasons healthcare is as expensive as it is. We spend money trying to smooth away every little wrinkle in life. Grouchy wife or mother? An anti-depressant will even out your moods. Angry young man? Prozac will make you happy. Or at least, it will make you not care.

    posted by Sydney on 3/28/2006 08:51:00 PM 9 comments


    I'm curious about the town where you formerly practiced and adults were on Prozac/kids on Ritalin: Was this an affluent place? That, at least, was my exprience. In a place where people think everything is for sale, they tended to think of doctors as commodities to be bought and sold. Consequently these people would spare no expense on mood altering drugs to medicate their unhappiness.

    By Anonymous Anonymous, at 9:09 PM  

    It was a small town dominated by a liberal arts college. Most of the people were well educated and relatively affluent. (Summer vacations to Europe were common place.) They had a strong tendency toward self diagnosis and prided themselves in their knowledge of all the best and latest therapies - largely gleaned from the mainstream press.

    By Blogger sydney, at 9:36 PM  

    I have been off & on anti-depressants for about 18 years, starting with post-partum depression after the birth of my second son. About 2 months ago I renewed my prescription cause I was feeling like I needed it. I went to the pharmacy to pick one month's supply (which was actually two month's, since I bit a 40 mg tablet in 2 to last me 2 months). It was $90! My first thought was "I'm not THAT depressed". My second thought was "If I thought I was depressed before, having to pay $90 to feel better will only make me MORE depressed."

    So, I'm off it. And I have started swimming 3 times a week, and will be bike-riding once the weather improves. I know that will do the job just as well for a lot less money.

    By Anonymous Anonymous, at 10:51 PM  

    A round of MPH and Prozac for my mates and I'll have whatever my man Sydney is having... make it a double!



    By Blogger Flea, at 8:30 AM  

    Money smooths away every little wrinkle in life not drugs.

    By Blogger Jake, at 4:16 PM  

    I have bipolar disorder, and I'm doing well on Lamictal. Still, my psychiatrist wants me on an antidepressant, 'just in case'. My last visit to her, she talked about me trying Cymbalta, a new antidepressant. Apparently, she's unaware of the information on the very first page of the www.Cymbalta.com website for doctors, which says it's only for patients with no history of mania.

    I've seen this before with any of the psychiatrists I've seen - they are too quick to keep adding one drug on top of another, and are sometimes unaware of the drug interactions.

    A former psychiatrist of mine told me that Xanax is not addictive. Like a fool, I believed him.

    By Anonymous Anonymous, at 5:07 PM  

    Antidepressants may be a victim of over-marketing. With the over-marketing both to physicians and direct to consumers, we quickly lose sight of exactly what these medications are for and for whom they are appropriate. Antidepressants don't work well for patients with "adjustment reactions" or chronic dysthymic patients, and these are the bulk of what we see in primary care. When antidepressants don't seem to be effective in patients for whom they probably should not be prescribed in the first place, they get a bad reputation and nobody wants them at all. On the other hand, I've had patients with acute major depression, and Prozac has given them back their life. Medicine has to be turned back into a serious intellectual profession which does not react to marketing-influenced patient demands and expectations. I have told the drug detail people that either they provide me with serious, valid, evidenced-based data on their products or they will be loudly ridiculed and thrown out of my office.

    By Anonymous Anonymous, at 5:34 PM  

    A lot of the literature about positive emotions (such as happiness) tends to mis-use statistics related to the prescription rate for anti-depressants. There is a tendency to discuss unhappiness as if it is an acknowledged prodrome for depression rather than part of the usual rhythm of life.

    I acknowledge my confusion over the findings that treating depression is worth the cost. And I assume that there is some basis to the claim that there are demographic groups (such as young men) where depression is under-diagnosed and under-treated with serious consequences.

    Nonetheless, I am indebted to Dr Ibear of Doc Around The Clock for this reference to a fine essay on Serotonin and Depression: A Disconnect Between the Advertisements and the Scientific Literature. It is possibly people's own experience of this disconnect that lies behind any fall in prescription rates?

    By Anonymous Happystance, at 1:33 PM  

    Boy, do I agree with this.

    When I started as a family doc, about 20 years ago, the world and his wife was taking Valium (and it was usually the wife). Having worked for several years to break that in my practice, I now find that SSRIs have taken over.

    As you rightly say, "smoothing out the wrinkles of life"

    People now expect to jump into a bottle of Prozac at the slightest upset.

    Meanwhile, "Big Pharma" is inventing more and more bogus applications for these drugs.

    It is the duty of family docs to try to be rational about this.


    By Blogger Dr John Crippen, at 1:58 AM  

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