Depression: Anatomy of an Epidemic
As a Middle America housewife and mother of four, I have noticed a disturbing trend over the last 10 years: more and more moms on antidepressants.
Well, it actually wasn’t disturbing to me until recently. I was under the impression that depression was a clear result of a chemical imbalance, a disease like diabetes and hypothyroidism. These wonder drugs were just curing a biological imbalance, right?
The more I paid attention to what I was putting in my body, however, the more I became weary. This led me to an eye-opening book: Anatomy of an Epidemic, by Robert Whitaker.
Since the 1950s, there has been a steady increase in psychiatric patients. One in 468 people were mentally ill in 1955, 1 in 184 people were mentally ill in 1987, and since the approval of Prozac in 1987, 1 in 76 people are considered mentally ill today. Now, 1 in 8 Americans take psychiatric drugs on a regular basis. Psychiatric drug sales currently exceed cholesterol-lowering drugs and are many pharmaceutical companies biggest cash cow.
So, what is going on? We have better drugs, but more depressed people? I thought the drugs were supposed to fix people…
Well, it seems as if there is really no proof that our brains were broken in the first place. In fact, it wasn’t until the 1980s that psychiatry reorganized and marketed themselves as “brain fixers.” This new pharmaceutical medical model was sold to the public and everyone bought in. The problem is that no studies or research have ever been able to prove the “chemical imbalance” theory, although many have tried.
Numerous studies have been done to measure the cerebrospinal fluid to find the levels of serotonin and dopamine metabolites in “normal” versus “mentally ill” people. None of these have been able to prove that mentally ill people have any different levels of serotonin or dopamine than healthy individuals.
As a matter of fact, they know now that the drugs actually cause the brain to act abnormally. Thus, a depressed person’s brain starts out looking normal, and end up looking very unusual after taking antidepressants.
Our brains will constantly strive to maintain equilibrium. When a drug like Prozac, Zoloft or Lexipro (selective serotonin reuptake inhibitors, SSRI) is introduced, it inhibits the reabsorbtion of serotonin, allowing more serotonin to be available in the brain. But, our brains react by altering its structure and pathways. It will turn off serotonin making neurons in order to bring the serotonin levels back down to normal levels. This is why once on psychiatric drugs, one will have to continually increase the dose or switch medications.
This also makes it going off the drugs almost impossible. The brain has been altered; so going off the SSRI will mean an even lower level of serotonin available than when the patient started. When patients attempt to go off the drugs, the dip back into depression is taken as proof that the drugs work, that they must need them. Instead it is really proof that the brain has been severely altered. Only time will slowly return the brain to normal, if possible. If the drug has been taken for a long period of time, the brain may never be able to recover to previous normal function.
But studies have proven they work, right? That depends on how you look at it. Pharmaceutical companies typically run short-term studies. In the short run, patients do feel better because the serotonin levels are increased. They feel relief. Long term studies not backed by pharmaceutical companies, however, have only found one result: patients who DO NOT take drugs are better off in the long run. It seems as if there is a benefit to letting the depression run its course and using alternative methods like talk therapy, writing therapy and meditation.
For example, a Vanderbilt University study, found that people on antidepressants had a 76% chance of relapse within a year when the drugs were discontinued compared to a 31% relapse rate for patients given a form of cognitive talk therapy.
Andy Thomson, a psychiatrist at the University of Virginia, says, “The high relapse rate suggests that the drugs aren’t really solving anything. In fact, they seem to be interfering with the solution, so that patients are discouraged from dealing with their problems. We end up having to keep people on the drugs forever.”
Seeing how psychiatric drugs create a cycle of dependence with diminished long-term outcomes, it is surprising that they are frequently being prescribed to the mildly depressed and anxious. Moms, who are exhausted, stressed and impatient, are being advised to go on Lexipro as if it was no big deal. There is still the belief that the brain is in imbalance and this little pill will fix the disease. Even though the US Surgeon General has readily admitted the exact causes of depression are not known, the illusion that biological imbalances cause mental illness still permeate public opinion.
Is there ever a place for psychiatric drug? Obviously, in severe cases, drugs can help. Is it ever appropriate for the mildly depressed? Maybe, maybe not. It looks like in the long run, it can do more harm than good. They may be helpful in a depressive episode when an exit strategy is discussed upfront. But, if you do not make a plan to get off the drugs, a life of psychiatric pharmaceuticals is highly likely.
Mothers out there have to realize that running a household, raising children, and also working outside the home can feel draining, stressful, and often unsatisfying. Feeling depressed, anxious, and overwhelmed is not abnormal. Before you turn to antidepressants, consider diet, exercise, yoga, meditation and writing to alleviate the depression. Consider simplifying your life and clearing your calendar. There are many therapies and options out there. Even though drugs may seem like the quick fix, the amount of work it could take to get off them may be more difficult and grueling than taking the time to deal with the problems in the first place.
ok-was going to have to write a very long comment back on this subject, until the paragraph/disclaimer that these meds can be helpful in some patients. Agree that these drugs can be overprescribed, but they can also save lives in patients with clinical depression. Disclaimer,sold Prozac for years! I can tell you all about conflicting data to this:)
I’m glad you wrote in. I think that everything has its place and purpose. I am bothered, however, that taking these meds isn’t taken more seriously. I worry healthy people that may be going through hard times are unaware of the drugs effects and could fall into a never-ending cycle. Even the depressed housewife and mom can benefit if they know what they are getting into and have a plan of how they are going to get off! The more information out there to make that decision the better!
This is a topic I think about a lot, especially after spending much of my time in research studying individuals with Depression, Bipolar, and Schizophrenia. I do agree that the sky-rocketing sales and prevalence of these serious drugs is scary, and shouldn’t be taken lightly. However the research myself and others are involved in does truly show a biological, chemical imbalance in neurotransmitter, and genetic component to depression. So I don’t think that can be disputed. BUT, agree with the important research out there showing that cognitive-behavioral (talk) therapy appears to be the most effective, especially in combination with drugs. Drugs alone don’t seem to solve the problem, at least right now with what we know about these mental illnesses. And I do think it’s scary how getting on the drugs turns into a neverending cycle! Hopefully in the next few years there will be more research on ‘alternative’ medicine such as exercise, meditation, st. john’s wart, etc, as exercise for instance DOES change both the level of neurotrophic factor and neurotransmitters in the brain when done consistently over time.
I love having a brilliant sister-in-law with a PhD in neuroscience. Its a little annoying sometimes because she is smart, healthy, beautiful and nice….enough already! I really appreciate your input on this. I really hoped this would start a dialog so that people are thinking and researching before they make a choice. Thank you!
Lina, I love that you addressed this, it has become so prevalent, that it is taboo to speak out against the over use of these drugs.
When I was in my twenty’s I struggled with my mental health. I was doing talk therapy, and my therapist recommended one as a therapeutic tool.I was very resistant and she wore me down. I did finally take prozac and I felt immensely better initially. My dose went up and up. Then it was time to go off it. I was done with therapy. Life was unpleasant and intolerable. I went back on then off, on then off. I was getting all the subsequent scripts from a GP. No therapy, no other support. I finally decided for myself that I had to go off. I started to do all of the things I do now. Many of them are things you recommended. 15 years later I haven’t thought about it in a very long time until you shared this post.
My personal experience is that with it’s current usage it is a substance being abused. Not saying some people don’t need it, but let’s try less invasive routes first.
Thanks so much for this. I think this means more to people than reading my statistics. It is important that women don’t take this decision lightly. Very interesting…
Here is an angle on the cause of the depression epidemic that probably very few people will have even considered: many cases may be caused by an infectious agent.
I myself caught a virus (that also spread around my social connections), and without any doubt, precipitated mental state change in many of those who caught it. Increased susceptibly to stress occurred in many of the infectees. Fatigue, lethargy and depression were also common, as were increased memory problems. All suddenly appearing soon after catching this infection.
For those interested in this, see here:
Depression Virus
Viruses in Perspective
I suspect that this virus I caught is a new enterovirus. Enteroviruses are very hard to detect once they have formed a long term infection in the host.
That is very interesting. Do you think that your feelings of depression are a result of the virus itself or from feeling so sick for so long?
It is definitely more related to the virus: I know this because other people in my social group that caught this same virus, but who did not get “full-blown” chronic fatigue syndrome, have also suddenly experienced lingering depression and anhedonia.
Your average doctor does not have much in-depth understanding of the root biochemical causes of depression. The biochemical root causes will in general different in different individuals.
Anti-depressant drugs sort of mask the symptoms (by raising serotonin, etc), but without actually treating the root cause. Anti-depressant drugs like SSRIs are a chemical “one size fits all”: they don’t address the cause that has originally created the bad brain biochemistry, but simply try to realign the brain biochemistry back to a more normal state. These drugs can be useful to get through periods of say mild short-term illness, mixed with life stress, than works together as a cocktail to create depression.
In my case, I believe my depression was underpinned by brain inflammation (this inflammation itself was caused by the ongoing viral infection).
There is a lot of new research on how inflammation in the brain can initiate the biochemistry of depression. This inflammatory state is called “Sickness Syndrome”. Sickness Syndrome is found in many inflammatory conditions.
http://sicksyndrome.com/five_step_program.php
I managed to alleviate most of my depression by taking anti-inflammatory supplements (similar to those supplements recommended by the above Sickness Syndrome treatment program) .
When I stop this anti-inflammatory treatment, the depression returns.
By the way, I would recommend that everyone with depression test to see if their depression is caused by chronic brain inflammation.
To test this, you can simply try out the anti-inflammatory treatments detailed here:
http://chronicsorethroat.wordpress.com/site-map/chronic-fatigue-syndrome-research-chronic-fatigue-syndrome/