Healthy Skepticism Library item: 13493

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cohen R.
Antidepressants are on the rise
The Star Ledger 2008 Apr 11
http://www.nj.com/business/index.ssf/2008/04/antidepressants_are_on_the_ris.html

Full text:

The most widely prescribed drugs in America are not for pain or cholesterol management, heartburn or hypertension.

They’re for depression.

Doctors last year wrote 232.7 million prescriptions for antidepressants, more than any other therapeutic class of medication, according to the latest data from IMS Health, a market research firm. That represents an increase of 25 million prescriptions since 2003 and translates into an estimated 30 million patients in the United States who spent $12 billion on antidepressants in 2007.
The explosion in antidepressant scripts has set off a raging debate about whether such widespread usage means more people in need are being treated or suggests the medication is being overprescribed.

Charles Barber, author of a new book, “Comfortably Numb: How Psychiatry is Medicating a Nation,” said antidepressants can be very effective for people with severe and disabling mental illness.

But he said heavy marketing by drugmakers, Americans’ quest for a quick fix and a wider acceptance in popular culture have resulted in the use of antidepressants as “an instant cure for all emotional difficulties.”

“There is a confusion between major clinical depression, which is clearly a biological illness where medication is appropriate, and being depressed,” Barber said. “Life’s problems, or having a feeling of sadness or dislocation, have been medicalized.”

Antidepressants are among the top-selling products for a number of big drugmakers. According to IMS Health, the biggest-selling brands last year were Wyeth’s Effexor, which had $2.8 billion in U.S. sales; Eli Lilly’s Cymbalta, at $1.9 billion; Forest Laboratories’ Lexapro, at $2.6 billion; and GlaxoSmithKline’s Wellbutrin, which added $1.1 billion to the company’s coffers.

The increased use of these drugs has resulted in a number of studies to gauge their effectiveness.

One study, published by British researchers in February in the online journal PLos Medicine, looked at data from 35 clinical trials for the antidepressants Prozac, Effexor, Serzone and Paxil that had been submitted for review to the Food and Drug Administration.

The researchers concluded the drugs benefited the most severely depressed patients, but found they were only about as effective as a placebo for those who were mildly or moderately depressed. They suggested many people now taking these drugs don’t need them.

J. Douglas Bremner, a psychiatrist and head of Emory University’s clinical neuroscience research unit, said “the bottom line is that antidepressants don’t work as well as people think.”

“I prescribe antidepressants because sometimes they are better than nothing, but they are not a magic cure-all,” he said. “And they have been overused.”

THE DEFENDERS

A widely cited 2006 study on depression funded by the National Institute of Mental Health found use of more than one antidepressant, or trying a different medication when the first does not work, can result in effective treatment and recovery for many people who suffer from major, chronic depression.

In the so-called STAR*D study, researchers found one in three people with major depression who had not previously benefited from an antidepressant became symptom-free after adding a second medication. It also found one in four became symptom-free after switching to a different antidepressant.

Robert Bransfield, a Red Bank psychiatrist and secretary of the New Jersey Psychiatric Association, said there “certainly is a trend toward more use of medication” and less use of psychotherapy, in part because many health-insurance plans will not pay for such care. But he said antidepressants remain essential for treating many patients.

“I am still seeing more undertreatment than overtreatment,” Bransfield said. “I think people are undermedicated when you look at the negative impact of mental illness on our society.”

Bransfield said the PLos study looked at clinical trials with short-term usage of mostly older drugs and in settings that do not mirror the real world. In treating patients, he said, doctors can try different and sometimes multiple medications along with therapy to achieve positive results.

“They (the British researchers) have made incorrect assumptions,” Bransfield said. “The misuse of antidepressants is low compared to the people who need them and don’t get them.”

Psychiatric medications came on the scene in the 1950s and 1960s, starting with mood stabilizers such as lithium and Valium and antipsychotic drugs like Thorazine. They were followed in the ensuing decades by drugs such as Prozac, Paxil, Zoloft and a host of others that have been embraced by the medical profession and are now prescribed most frequently by family physicians.

THE CRITICS

Author Barber, who has lectured at the Yale University School of Medicine and worked at shelters for the mentally ill homeless in New York City, said antidepressants have been marketed by the pharmaceutical companies as “lifestyle enhancers.”

He said they have been used by celebrities, gained social acceptance and played prominent roles in movies such as “Garden State” and in television programs like “The Sopranos,” where mob boss Tony Soprano took Prozac, lithium and Xanax.

In the past few decades, Barber added, the Diagnostic and Statistical Manual of Mental Disorders, the bible of American psychiatry, has greatly expanded the number of psychiatric conditions that have provided a rationale for wider uses of the medications.

Carolyn Robinowitz, president of the American Psychiatric Association, said in any given year, one in five Americans experience a mental-health disorder, and only about one-third of them seek help.

Robinowitz said physicians should be careful about prescribing antidepressants, but added studies show 70 percent to 80 percent of people with depression get better with a combination of the right medication and talk therapy.

“So many people are wedded to the notion that people should just pull themselves up by the bootstraps, and they see a weakness of will,” Robinowitz said. “But these can be real disorders, and like other disorders, people can benefit from medication.”