Michele Belanger-Hicks
ISS 4935 Wednesday Class
Dr. Rebecca Johns, Spring 2012
Alternative Solutions to Medication in Fighting Depression
Introduction
Daily, in between prime time shows, a sad wind up doll in a frumpy outfit walks aimlessly with her head down across the television screen (Pristiq). She is desperately looking for something to wind her up and cure her down mood. Unfortunately, a lifetime of prescription drugs is not the key to improving a situation long-term. Prescription drug commercials dominate the media, is this contributing to the huge increase in prescription drug use, especially among women? Over the past few decades, there has been a dramatic increase in the amount of Americans who are prescribed antidepressants. There are numerous reasons for this upward trend as cases of depression, anxiety and sleeping disorders have increased especially among women in the United States. Is it the overwhelming task of trying to juggle the impossible? Nowadays, a woman is expected to have a successful career, be a good mother and wife, attend to the house and keep herself in shape and always with a smile. The task is daunting; has popping a pill become so easy and convenient that the underlying cause of why the person is depressed been overlooked and swept under the carpet, and considered resolved by a prescription? More attention needs to be given to psychotherapy assistance and alternative approaches to these problems versus just turning to medication. For many people, understanding the root cause of the problem and confronting it alleviates the need for long-term drug use. The benefits of trying to deal with emotional issues through therapy and other non-medical approaches include preventing people from becoming dependent on unnatural, mind altering and potentially harmful substances. Because of the astronomical rise in prescription antidepressant medications, particularly in women, and the harmful side effects, alternative solutions to depression, anxiety and sleeping disorders should be explored first, leaving the use of medication only as a last resort. The side effects of antidepressant use must be acknowledged and alternative ways to deal with mental disorders investigated before resulting to drugs. In this paper I will research and evaluate the other options to prescription drugs for the treatment of mental disorders. If, indeed the other approaches are unsuccessful and the need for medication is determined, the patient should be properly evaluated by a qualified psychiatrist before administering antidepressants and then put on a regularly scheduled program with a psychologist/psychiatrist who follows the patient's progress.
What are Antidepressants and How do they Work?
Antidepressants are drugs used to treat a variety of ailments, including depression. They work by increasing the level of natural chemicals, serotonin, norepinephrine, and dopamine in the brain called neurotransmitters, which control our moods and emotions (“Mental Health Medications”). The most commonly prescribed group of antidepressants in recent years are selective serotonin reuptake inhibitors (SSRIs), which include these popular medications, Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), Paroxetine (Paxil), and Escitalopram (Lexapro) (“Mental Health Medications”). Other antidepressants include serotonin norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) (Science of Mental Illness”, 1). Antidepressants biologically work to combat mental disorders by increasing the mood enhancing chemicals in our brains (Science of Mental Illness”, 1). Each drug has its own individual process of dealing with the human brain; therefore people might react differently to various medications. Studies show that people can have completely diverse reactions to different medications and that is why it is extremely important that all symptoms are notated and reported immediately to a health care professional (Science of Mental Illness”, 1).
Increase in Use of Antidepressants
The increase in the amount of people, especially women in the United States being prescribed antidepressants is phenomenal. The U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) released figures on the use of antidepressants in people over the age of 12 during the years 2005-2008 and compared that data with statistics from 1988-1994 (Pratt, Brody). Astoundingly, the increase amongst all Americans grew almost 400% (Pratt, Brody). Surprisingly though, there are still so many victims of depression that go undiagnosed for one reason or another, whether it is lack of healthcare coverage, money, embarrassment, or access to a mental health provider, the amounts are staggering (Pratt, Brody).
The study also uncovered that antidepressants are the third most prescribed medication in the United States and for people between the ages of 18-44; antidepressants top the list (Pratt, Brody). Women are 2 ½ times more likely to take antidepressants than men, with approximately 15% of all women over the age of 12 on antidepressants (Pratt, Brody). Women, in general, dominate in prescription drug use but white women exceed African American women and Hispanic women by significant proportions (Pratt, Brody). White women between the ages of 40 – 59 overwhelmingly stand out as the highest segment of people taking antidepressants (Pratt, Brody). In 2008, over 23% of white women were consuming antidepressants (Pratt, Brody). Women taking antidepressants have made these pills part of their everyday routine for years, just like having a cup of coffee every morning. The CDC points out that over 60% of women taking antidepressants have been taking them for over 2 years, with 14% exceeding 10 years (Pratt, Brody). Approximately 8% of people taking these medicines display no signs of depression (Pratt, Brody). These escalating numbers warrant our health care system to invest in what the repercussions are of so many women being on prescribed medication and investigating into what alternatives there are besides drugs. Although I will touch on related issues to the antidepressant craze, my main focus will be what other options are available in addition to long-term drug use.
Why the Increase in Antidepressants?
What has caused the dramatic jump in antidepressants usage? Several elements have been blamed for the excessive upsurge in prescription drug use. One factor that has changed over the last couple of decades has been the emphasis on diagnosing and screening for depression at general practitioners’ offices and the more openness of this illness as actually being a legitimate disease. Living silently with depression can be catastrophic, so being aware of the symptoms of depression is a step forward in combating this disorder. Perhaps for many years people suffered silently behind closed doors and now society is more open to admitting how significant this disease can be and how important it is that depression be addressed. The Healthy People organization through the U.S. Department of Health and Human Services has established targets on educating and addressing mental health issues and reducing the negative outcomes mental disorders have on a community (U.S. Department of Health and Human Services). The Healthy People objective has been around for several decades and its mission has been to mobilize, assess, plan, implement, track (MAP-IT) depression results, meaning setting objectives, monitoring outcomes and reporting back progress of people suffering from this disease (U.S. Department of Health and Human Services). The goal has been for more primary health care providers to be educated in detecting depression by screening adults 19 and older for depression, and referring them to specialists to help patients with depression symptoms (U.S. Department of Health and Human Services).
Another reason for the upswing in antidepressant usage is the constant bombardment of drug advertisements in the media. Whether reading a magazine, watching television or listening to the radio, pharmaceutical companies are imprinting their message of the benefits of taking their drugs. The media and pharmaceutical companies are playing a huge role in the increase in antidepressant prescriptions among women. Over the years more and more commercials and magazine ads are glamorizing the results of taking antidepressants and giving the impression that many issues can be solved with a pill. In August of 1997, the Food and Drug Administration (FDA) approved that drug companies could now not only market via magazines and newspapers with their brand name but directly market to consumers, also known as direct-to-consumer advertising (DTCA), with television commercials (Iizuka, Zhe Jin, 703). With this win from the FDA, pharmaceutical companies’ expenditures on DTCA marketing leaped from $800 million in 1996 to $2.5 billion in 2000 (Iizuka, Zhe Jin, 703). The drug companies’ perspective claims that many disorders go undiagnosed and by advertising people are more likely to head to the doctors to address and improve their condition ((Iizuka, Zhe Jin, 703). That might be true; however, this upsurge in advertizing could lead to patients requesting medicine because of the skillfully designed commercials illustrating the so-called wonders of using the drug. This tactic encourages people to pay for more expensive drugs when in many cases an over the counter solution would have been just as effective (Iizuka, Zhe Jin, 703). What the pharmaceutical companies also fail to mention is that once a drug goes generic and the potential profits decline, they stop advertising the product and focus on one that is still patented (Shorter, 38). Of course, with all this exposure, the drug companies are pushing the pros of antidepressants. As expected with the drug companies flooding the wavelengths with their commercials, doctor visits, especially in women, surged from 1997 to 2000, wearing out the physicians’ prescription pads and resulting in the soaring pill phenomena we are witnessing today (Iizuka, Zhe Jin, 703).
Why the Difference in Gender?
The major factor that contributes to the considerable gap that exists between the number of women prescribed antidepressants compared to men, is simply that women are more apt to visit a doctor than men. The CDC reports that women are 33 percent more likely to visit a doctor than men are (“New Study Profiles Women’s Use of Health Care”). In some studies of annual exams and preventive care, women visited physicians 100 percent more than men (“New Study Profiles Women’s Use of Health Care”). Women go to the doctor for a variety of reasons, while depression might be one of the main ailments often other issues such as preventative exams was the main reason for the visit and during the appointment other complaints are discussed, resulting in a diagnosis of a mental disorder.
Women are also driven to the doctors’ office for multiple other reasons that are interfering with their lives. Annoyances such as experiencing depression, sleep disorders, anxiety disorders, and compulsive disorders that are distracting from the normal balance of happiness and contentment that women strive for, therefore leading them to find a solution to these disturbances. Antidepressants are prescribed and taken for conditions ranging from the above mentioned conditions as well as postpartum depression, stress, eating disorders, menopause, and bipolar condition, just to name a few (“Science of Mental Illness”, 1). Many mental disorders are closely related, meaning one disorder contributes to the other disorder, consequently antidepressant medications are being prescribed for other reasons besides just depression (“Science of Mental Illness”, 1). I have focused on depression as the leading reason for women being prescribed antidepressants but it is very important to point out the various other causes of why antidepressants are being prescribed.
Definition and Symptoms of Depression
What in fact is the definition of depression? There are many different indicators and severities of depression; symptoms can vary from feeling down or lethargic, to as severe as feeling absolutely hopeless and wanting to commit suicide. These feelings, in order to be classified as depression, must be consistent over a period of time and affecting one’s everyday life (“Major Depressive Episode: DSM IV Diagnosis’). Throughout history there has not been a standardized method of diagnosing mental disorders, so The American Psychiatric Association came up with a manual, known as the Diagnostic and Statistical Manual of Mental Disorders or DSM to define and categorize mental disorders into specific categories that are consistent across the United States (Gray, 615). The DSM has many different categories of depression, however, in most cases, classification depends on the severity and length of the symptoms. The standard questioning that the DSM IV uses to define if a person is suffering from a depressive episode is the following:
The patient must have a total of at least 5 symptoms from the list below for at least 2
weeks and one of the symptoms must be depressed mood or loss of interest.
· “depressed mood most of the day, nearly every day
· markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
· significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
· insomnia or hypersomnia nearly every day
· psychomotor agitation or retardation nearly every day
· fatigue or loss of energy nearly every day
· feelings of worthlessness or excessive or inappropriate guilt nearly every day
· diminished ability to think or concentrate, or indecisiveness, nearly every day
· recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.”
(“Major Depressive Episode: DSM IV Diagnosis’).
What Causes Depression in Women?
The gauntlet of tasks that the average woman is responsible for is so overwhelming and sometimes humanly impossible to accomplish, that often women feel defeated, leading to the symptoms of a mental disorder. The cause of depression in women varies from one woman to another. Some of the top reasons for depression in our society are coping with life's multitude of stresses. Managing a career, taking care of children along with all the other responsibilities is very straining both mentally and physically, often leaving women feeling extremely overwhelmed and helpless, resulting in depression (Lafrance, 5). Other obvious aspects that lead to depression are truly environmental such as living in poverty, physical and verbal abuse from a violent partner, and discrimination and racism (Lafrance, 5). Although, environmental surroundings play a key part in many causes of depression, it is also critical to point out that there are also biological mental disorders that affect the chemical imbalance of the brain. Hence, it is extremely important to emphasize the significance of having a qualified professional accurately diagnose these disorders.