Why are antidepressants the most prescribed drug in the U.S.?

Zoloft, Paxil and Prozac are some of the most common antidepressants. See more drug pictures.
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In 2007, the Centers for Disease Control and Prevention made an intriguing announcement. Antidepressants were the most frequently prescribed drug, overtaking the runner-up, high blood pressure medications, by five million prescriptions. The study reported that doctors racked up 118 million prescriptions for antidepressants in 2005 (out of a total of 2.4 billion prescriptions) [source: Cohen].

What does this remarkable surge in antidepressant popularity say about how our society now views depression?

Before the 1980s, seeing a psychiatrist was the preferred treatment for depression. But advances in technology have allowed new insights into the workings of the brain and instigated a growing interest in antidepressants. Now, even primary care physicians, not just psychiatrists, have become frequent prescribers [source: Lieberman]. Between 2005 and 2008, 11 percent of Americans 12 and up were taking antidepressants [source: CDC].

Antidepressants have the power to change your moods, and they accomplish this by affecting the amount of serotonin and norepinephrine in the brain. Serotonin and norepinephrine are neurotransmitters, which travel through neurons in the brain. Scientists don't know a great deal about how these neurotransmitters affect your mood. But they do know that when antidepressants alter how neurotransmitters travel, it stabilizes your emotions. To learn more about this process, read How Antidepressants Work.

So what's the reason behind the rising number of antidepressant prescriptions? One reason is that, despite their name, antidepressants are not prescribed solely for depression anymore. They are also used to treat chronic pain, anxiety, panic disorder, obsessive compulsive disorder and even eating disorders. Another reason could be that more people are confiding in their doctors about their struggles with depression. When you think of it that way, it seems like a positive trend in the United States -- patients are comfortable sharing the problem with doctors, and doctors are recognizing and treating it.

But the numbers also raise questions about misdiagnosis and overprescription. Are we too quick to throw a prescription at any old emotional problem? Read on to learn more about this debate.

 

Do doctors overprescribe antidepressant medications?

You can't really address the reasons for antidepressant popularity without addressing the business of antidepressants. In 2004, brand-name antidepressant companies made more than $14 billion [source: ResearchandMarkets]. These sales mean big business, and direct-to-consumer advertising (such as television commercials) has helped fuel it. Studies indicate that this kind of advertising has contributed to the growth in prescriptions [source: Kravitz]. When patients see commercials for antidepressants, such as Zoloft, and think that it can help them, they go to their doctors and request it. Doctors are more likely to prescribe an antidepressant when a patient specifically asks for it.

Some believe doctors are usually too anxious to diagnose someone with depression. The symptoms for depression from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) include:

  • Depressed mood
  • Taking less pleasure in life
  • Changes in appetite
  • Changes in sleeping pattern
  • Restless habits
  • Lack of energy
  • Feeling worthless or guilty
  • Inability to concentrate
  • Suicidal thoughts

[Source: Wise]

But even with these parameters, distinguishing severe depression from natural periods of feeling "down" can be a murky call. Professor Gordon Parker thinks doctors interpret the common blues as clinical depression all too often [source: BBC News]. In a long-term study he conducted, he found that a great majority of people could be diagnosed as depressed on the criteria that doctors use. He took this to mean the criteria for depression is too loose.

It appears the combination of consumer advertising and doctors' difficulty in definitively diagnosing clinical depression could have contributed to the rise in antidepressant use. Still, others support the increase in antidepressant use, arguing that it is better to diagnose depression too often than too little.

If you are hesitant to take antidepressants or don't think your condition is severe enough to warrant therapy, you have options. Regular exercise, for instance, can dramatically relieve depression. In addition, maintaining a balanced, nutritious diet and reducing the intake of stimulants, such as cigarettes and caffeine, can help as well. For more information about antidepressants and other related subjects, go to the next page.

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Sources:

  • "Almost Half of Americans Use at Least One Prescription Drug Annual Report on Nation's Health Shows." Center for Disease Control and Prevention. Dec. 2, 2004. (Feb. 22, 2008) http://www.cdc.gov/nchs/data/databriefs/db76.htm
  • "Antidepressants Can Increase Depression, Impulsivity and Suicide Risk by Decreasing Dopamine." Biotech Business Week. Feb. 25, 2008.
  • "Antidepressants: Get tips to cope with side effects." MayoClinic.com. (Feb. 22, 2008) http://www.mayoclinic.com/health/antidepressants/MH00062 http://news.bbc.co.uk/2/hi/health/6950733.stm
  • Cohen, Elizabeth. "CDC: Antidepressants most prescribed drugs in U.S." CNN.com. July 9, 2007. (Feb. 22, 2008) http://www.cnn.com/2007/HEALTH/07/09/antidepressants/index.html
  • "Depression is 'over-diagnosed'." BBC News. Aug. 17, 2007. (Feb. 22, 2008)
  • "FDA Launches a Multi-Pronged Strategy to Strengthen Safeguards for Children Treated With Antidepressant Medications." U.S. Food and Drug Administration. Oct. 15, 2008. (Feb. 22, 2008)http://www.fda.gov/bbs/topics/news/2004/NEW01124.html
  • "Impact of Generics on the Antidepressant Market." Decision Resources, Inc. Dec. 2005. http://www.researchandmarkets.com/reportinfo.asp?report_id=314820&t=d&cat_id=
  • Kravitz, Richard L., Ronald M. Epstein, Mitchell D. Feldman, Carol E. Franz, Rahman Azari, Michael S. Wilkes, Ladson Hinton, Peter Franks. "Influence of Patients' Requests for Direct-to-Consumer Advertised Antidepressants." The Journal of the American Medical Association. (Feb. 22, 2008)http://jama.ama-assn.org/cgi/content/short/293/16/1995
  • Lieberman, Joseph A. "History of the Use of Antidepressants in Primary Care." Physicians Postgraduate Press. 2003. (Feb. 22, 2008) http://www.psychiatrist.com/pcc/pccpdf/v05s07/v05s0702.pdf
  • Pick, Marcelle. "Antidepressants and alternative treatments for depression." WomentoWomen.com. (Feb. 22, 2008) http://www.womentowomen.com/depressionanxietyandmood/antidepressants.aspx
  • Wise, Michael, James R. Rundell. " Textbook of Consultation-Liaison Psychiatry." The American Psychiatric Publishing, Inc. (Feb. 22, 2008) http://books.google.com/books?id=RfOdhmau8jwC&printsec=frontcover&dq=%22dsm+iv%22+%22criteria+for+depression%22+american+psychiatric+association&source=gbs_summary_r