Are Antidepressants Overprescribed?

In October of 2011, the Centers for Disease Control and Prevention released a report that stated that American antidepressant use had increased by 400% from 1988 to 2008. The report found that one in twelve Americans over the age of twelve is taking antidepressants to treat depression, anxiety and other mental illnesses.

Many saw the meteoric increase of antidepressant use as a sign of a weak economy, increased awareness about mental health, and aggressive pharmaceutical ad campaigns. Some people found these reasons insufficient in explaining why antidepressants are the third most common prescription drug taken by Americans “of all ages,” according to the National Center for Health Statistics. What certain people wanted to know was: are antidepressants overprescribed?

There are a host of drugs on the market that treat depression and other mental illnesses. The most popular ones are called selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Celexa, Zoloft and Lexapro (all brand names). They affect the way different neurotransmitters work (neurotransmitters are chemicals that provide “communication” between nerve cells in the brain). According to David M. Reiss, MD, psychiatrist and Interim Director of Providence Behavioral Health Hospital in Holyoke, MA, many Americans have difficulty discerning between normal sadness and clinical depression. While depression runs on a spectrum, Dr. Reiss says warning signs of serious depression include:

  • Significant disruptive physical symptoms (extended and disruptive insomnia, gastrointestinal distress, or muscular-skeletal symptoms)
  • Dangerous behavior towards self or others (suicide attempts, self-injury, violence towards other people or animals)
  • Unreasonable risk taking (alcohol or drug abuse, for instance)
  • An inability to function practically at work or home
  • Disruption in relationships with family and/or loved ones

“There is less stigma attached to taking anti-depressants,” Dr. Reiss says, “so more people who are depressed are obtaining needed treatment.” But, he adds, people often confuse normal sadness with depression, and this confusion can be detrimental to their mental health: “I often see patients who would do better with counseling or therapy to help them identify, explore and try to resolve their problems and their uncomfortable emotions, rather than relying on medication to ‘hide-away’ appropriate, though uncomfortable, feelings.”

Practical life problems, he stresses, do not get resolved by taking medication; he also says that taking antidepressants when you’re not depressed can make your circumstantial sadness morph into “larger problems…’true’ and much more serious clinical depression.”

And while Americans may have problems telling the difference between normal sadness and clinical depression, physicians also play a role. “Any licensed physician can prescribe antidepressants,” says Dr. Reiss. “It is an ‘easy’ response to a ‘complaining’ patient.” Unless there is “significant disruption or danger” Dr. Reiss says that patients should try counseling and non-medical interventions first. He also warns patients to be wary of doctors who, when what they prescribe is not effective add other medication or quickly change which medication is used instead of reevaluating the situation. He also warns against doctors who offer prescriptions without a follow-up contact within two weeks.

His worries are reflected in the NCHS data brief, which states that less than one-third of people taking a single anti-depressant have seen a mental health profession in the past year.

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If you or a loved one need help, call the Veterans Crisis Line at 1-800-273-TALK (9255), Press 1.

For more information on depression, visit the National Institute on Mental Health’s website.