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Over 30,000,000 Americans take prescription antidepressants. And among Americans aged 18 to 44, antidepressants are prescribed more frequently than any other class of medication, reports a new study released by the US Centers for Disease Control (CDC).

More Americans Aged 18 to 44 on Antidepressants Than Any Other Medication

Using data collected by the National Health and Nutrition Examination Surveys between 2005 and 2008, the National Center for Health Statistics also reports that:

  • More than twice as many women are on antidepressants as men.
  • Whites are more likely to take antidepressants than Blacks.
  • The majority of Americans who take antidepressants have been using the medications for two years or more, 14% of Americans on antidepressants using them for 10 years or more.
The CDC also reports that most Americans taking antidepressants never see a psychologist, psychiatrist, or other mental health worker. Most prescriptions for antidepressants are handed out by family practice physicians.

Why are antidepressants so commonly prescribed?

Part of the reason may be that antidepressants are not just for depression any more. Some of the older-style antidepressants, such as Elavil (amytripytiline) are a very inexpensive but effective treatment for diabetic neuropathy. The makers of Prozac, Paxil and other antidepressants released in the late 1980's and early 1990's have dealt with expiring patent protection by finding new, patent-protected indications for their drugs that help preserve company profits. Meds that used to prescribed exclusively for depression are now offered for anxiety, obsessive-compulsive disorder, muscle tremors, social anxiety disorder, and fibromyalgia.

A good example of how pharmaceutical companies expand the markets for their drugs is duloxetine, marketed as Cymbalta.

Duloxetine was originally intended as a drug for major depression. Three out of six clinical trials, however, found that was no more useful than a placebo, and other clinical trials found that it was 30% to 40% less effective than Effexor (venlafaxine) and Zoloft (sertraline). Duloxetine also interacted with other medications and caused liver damage. Famously, some patients committed suicide when they were switched from duloxetine to a placebo.

Not willing to let hundreds of millions of dollars of research go to waste, Eli Lilly then tested duloxetine as a treatment for urinary incontinence in women. The clinical trial found that taking duloxetine reduced the frequency of "accidents" by 57%, but that women still had to wear pads or adult diapers.

Then duloxetine was tested as a treatment for diabetic neuropathy. It was found to reduce pain but not to repair nerve damage. Eli Lilly subsequently ran clinical trials of duloxetine as a treatment for generalized anxiety disorder. The treatment was found not to cause as many side effects when it was used to treat anxiety as when it was used to treat depression—but no major health organization was willing to use it.

Most recently, Eli Lilly is selling duloxetine under the Cymbalta trademark as a remedy for pain and depression caused by fibromyalgia. It seems to work in women but not in men for up to 12 weeks. And the company is marketing this drug for bladder infections and chronic fatigue syndrome.

Cymbalta may be an extreme example of a drug seeking a purpose, but other early antidepressants have been marketed with similar zeal. When Prozac's patent expired, Eli Lilly came up with an extended-release form. Prozac is now used to treat obesity, anorexia, bulimia, bipolar disorder, alcoholism, and PMS. When Paxil was found to cause erectile dysfunction, GlaxoSmithKline made it available as a treatment for premature ejaculation.

While pharmaceutical companies find more and more justifications for their products, insurance companies pay less and less for in-person sessions with therapists. The old method of seeking psychological growth through therapy has been replaced by the more profitable method of popping a pill.

Is depression really on the rise in the USA? Internet news reporting and social media certainly give Americans more ways to report, complain, and learn about depression. Treating mild to moderate depression with medications certainly is on the rise, but actually fewer people than ever before require hospitalization.

  • Li G, Wang LY, Shofer JB, et al. Temporal Relationship Between Depression and Dementia: Findings From a Large Community-Based 15-Year Follow-up Study. Arch Gen Psychiatry. Sep 2011.68(9):970-7.
  • Photo courtesy of amymessere on Flickr: www.flickr.com/photos/amymessere/3313106504