13% of Americans take anti-depressants, why?

[Kris]

I'm going to admit I haven't read the rest of this thread, though I will. But I was attracted to the subject line because of something that recently occurred.

About a month ago, I was hanging out with a group of friends over drinks, and in the course of the conversation, the topic turned to antidepressants, and then meds in general. Everyone else at the table was taking at least one medication for a physical and/or mental ailment. So were all of their spouses. I was the only exception. I've never taken anything (other than for a few days if I was ill) except for birth control, my whole adult life. I'm 51. And I am starting to realize just how unusual that is.

I was... sort of flabbergasted.

[wenchsenior]

I'm going to admit I haven't read the rest of this thread, though I will. But I was attracted to the subject line because of something that recently occurred.

About a month ago, I was hanging out with a group of friends over drinks, and in the course of the conversation, the topic turned to antidepressants, and then meds in general. Everyone else at the table was taking at least one medication for a physical and/or mental ailment. So were all of their spouses. I was the only exception. I've never taken anything (other than for a few days if I was ill) except for birth control, my whole adult life. I'm 51. And I am starting to realize just how unusual that is.

I was... sort of flabbergasted.

I was just engulfed by a sort of despairing wave of envy.  Really. 

[AnnaGrowsAMustache]

I think a lot of folks have a problem with people taking medication to control depressive disorders, because 1.) We've been told that chemicals are evil, even though everything in the world except for energy is made from chemicals and 2.) People with depression show no physical symptoms of the disorder since it's an illness of the mind and not of the body. As I've struggled with major depressive disorder throughout my life, people usually told me to just get over it and then tell me I was lazy, which is kind of like telling someone with diabetes that they should get over their illness and stop making excuses.

I can tell you anecdotally that taking medication has changed my life dramatically, which people who've read my journal have probably noticed. I wish I had been able to get the help I needed earlier in my life, but unfortunately the healthcare system in the USA is woefully inadequate.

We're made of chemicals. That's why we use chemicals to treat ourselves. And people do show physical symptoms of depression - substance abuse, self harm, eating disorders, long term anxiety induced changes in blood pressure and cardiac events, inability to get out of bed in the morning....

The people who told you to get over it are idiots. As you well know, you're not lazy. What you are is overwhelmed. Meanwhile, feeling like crap when crap things happen, like if someone dies or you lose your job, is normal. Feeling like crap when there's no particular cause is not normal. No one would expect you to get over it if someone died, or you lost your job. Why should you be better able to get over something that's actually a chemical imbalance? I'll tell you what's lazy - being so unwilling to find out what's wrong with someone that you just tell them to get over it!!?! That's lazy thinking.

Rant over.

 

[milliemchi]

The field of clinical psychology is not a science (although it's sold to many as such).

I'm going to stop you right there. While there are a lot of critiques that can be levied at clinical psychology due to the application of the scientific method, the field is a science that applies the scientific method.

Psychology has failed to provide a body of knowledge with a clear, unified core of beliefs.  Information (that is often gained by painstakingly following the scientific method) is of little or no value without this.

A behavioral psychologist operating today has different expectations, will look for different problems, and will use different treatments than a Freudian psychologist operating fifty years ago. . . but these differences are not rooted in proof that Freudian psychoanalysis is wrong - they're not rooted in any proof that behavioral psychology is right.  The core of what psychology is is ruled by fad, societal whim, and not by scientific rigor.  The DSM is just one a symptom of this problem.  Another is that you can go with the same symptom to ten different psychologists and get ten different diagnosis.  There's the failure to use clear terminology and quantifiability in results generated.  Another is that it cannot describe what 'normal' is . . . the very state that it is attempting to return it's subjects to.  This list goes on and on.

It's a fixable problem, and I hope that it gets fixed.  Some fields of psychology really seem to be working on it.  In the clinical sense though, we're miles away from being scientific.



Note - I'm not arguing that seeing a psychologist is a bad idea, or that taking antidepressants is wrong.  If you feel that it's going to make you happier and healthier, it may well do just that.  If it's not working for you, then don't put unfounded faith in the practice.

What are you talking about?

The reason people take medication is that it was proven to work in clinical trials. And the reason Clinical Psychologists (PhDs) get such great results is because their techniques have been proven effective in clinical trials. I've seen both work wonders on people.

It's not an exact science, but it is a science.

P.S. Freudian analysis is sh*t and is not used anymore because it is not helpful, not because one fad replaced another.

[GuitarStv]

The field of clinical psychology is not a science (although it's sold to many as such).

I'm going to stop you right there. While there are a lot of critiques that can be levied at clinical psychology due to the application of the scientific method, the field is a science that applies the scientific method.

Psychology has failed to provide a body of knowledge with a clear, unified core of beliefs.  Information (that is often gained by painstakingly following the scientific method) is of little or no value without this.

A behavioral psychologist operating today has different expectations, will look for different problems, and will use different treatments than a Freudian psychologist operating fifty years ago. . . but these differences are not rooted in proof that Freudian psychoanalysis is wrong - they're not rooted in any proof that behavioral psychology is right.  The core of what psychology is is ruled by fad, societal whim, and not by scientific rigor.  The DSM is just one a symptom of this problem.  Another is that you can go with the same symptom to ten different psychologists and get ten different diagnosis.  There's the failure to use clear terminology and quantifiability in results generated.  Another is that it cannot describe what 'normal' is . . . the very state that it is attempting to return it's subjects to.  This list goes on and on.

It's a fixable problem, and I hope that it gets fixed.  Some fields of psychology really seem to be working on it.  In the clinical sense though, we're miles away from being scientific.



Note - I'm not arguing that seeing a psychologist is a bad idea, or that taking antidepressants is wrong.  If you feel that it's going to make you happier and healthier, it may well do just that.  If it's not working for you, then don't put unfounded faith in the practice.

What are you talking about?

The reason people take medication is that it was proven to work in clinical trials. And the reason Clinical Psychologists (PhDs) get such great results is because their techniques have been proven effective in clinical trials. I've seen both work wonders on people.

It's not an exact science, but it is a science.

P.S. Freudian analysis is sh*t and is not used anymore because it is not helpful, not because one fad replaced another.

The reason that people generally take medication is that they're prescribed it.  I've already posted a link showing that antidepressants (as an example) benefit 40-60% of people who are prescribed them.  20 - 40% of people benefit from a placebo in place of an antidepressant.  So, roughly half the people who are prescribed antidepressants do not benefit from them . . . and roughly half of the people who antidepressants 'work wonders on' would do just as well with sugar pills.  Then there are the many studies showing that talking to someone about your problem is often about as effective as taking pills for it (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/ for example).

Patients who take pills because they're prescribed them are in a particularly dangerous place if they don't work.  Getting a prescription from a doctor carries with it weight and authority because medicine is a science.  This weight and authority carries over with a prescription from a psychologist . . . but as we've seen, the prescription often won't work.  For someone already depressed, having this faith dashed could carry quite serious consequences.

All that aside for a moment (getting back to the science problem), there is a fundamental issue with something claiming to be science with the goal of returning a person's mental state to normal . . . that is unable to define 'normal'.  It makes it extremely difficult to do meaningful research.  How does one mark a patient in the 'cured' column if there's no definition of what 'cured' means?  It's not possible to validate research, and any research done becomes extremely suspect.  I'm aware that some of the fields in psychology (neuropsychology for example) are improving, creating a model for normal (typically through brain scans and chemical measurement)  and accepting evidence based research now, but it's still a deeply rooted problem for the therapy based side of things.  Until the fundamental problems with psychology are corrected, much of the research done will naturally be limited in what can really be proven.  Right now, much of psychology is at the stage medieval alchemy was at . . . they're poking around aimlessly at stuff they don't understand.  Yes, it appears to slowly be heading in the direction of a science (just as alchemy evolved into chemistry), but calling it one at this juncture is premature.



P.S.  The psychoanalysis that you've claimed "is sh*t" and "is not helpful" has actually been the only therapy shown effective for some anxiety disorders in the clinical trials that you claim to put so much faith in (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623560/).  This of course, is the risk of basing your opinion of something on popular fad rather than on research . . . you find that when research is done, it doesn't always agree with your personal prejudices.  Now, you can certainly argue that since psychology has not proper definition of what normal is that the researchers may have fudged the numbers to support the case they wanted to see - that's a valid concern.  Doing so would invalidate your argument that psychology is a science though.  Bit of a catch-22 you've dug yourself into there.

[PeteD01]

The field of clinical psychology is not a science (although it's sold to many as such).

I'm going to stop you right there. While there are a lot of critiques that can be levied at clinical psychology due to the application of the scientific method, the field is a science that applies the scientific method.

Psychology has failed to provide a body of knowledge with a clear, unified core of beliefs.  Information (that is often gained by painstakingly following the scientific method) is of little or no value without this.

A behavioral psychologist operating today has different expectations, will look for different problems, and will use different treatments than a Freudian psychologist operating fifty years ago. . . but these differences are not rooted in proof that Freudian psychoanalysis is wrong - they're not rooted in any proof that behavioral psychology is right.  The core of what psychology is is ruled by fad, societal whim, and not by scientific rigor.  The DSM is just one a symptom of this problem.  Another is that you can go with the same symptom to ten different psychologists and get ten different diagnosis.  There's the failure to use clear terminology and quantifiability in results generated.  Another is that it cannot describe what 'normal' is . . . the very state that it is attempting to return it's subjects to.  This list goes on and on.

It's a fixable problem, and I hope that it gets fixed.  Some fields of psychology really seem to be working on it.  In the clinical sense though, we're miles away from being scientific.



Note - I'm not arguing that seeing a psychologist is a bad idea, or that taking antidepressants is wrong.  If you feel that it's going to make you happier and healthier, it may well do just that.  If it's not working for you, then don't put unfounded faith in the practice.

What are you talking about?

The reason people take medication is that it was proven to work in clinical trials. And the reason Clinical Psychologists (PhDs) get such great results is because their techniques have been proven effective in clinical trials. I've seen both work wonders on people.

It's not an exact science, but it is a science.

P.S. Freudian analysis is sh*t and is not used anymore because it is not helpful, not because one fad replaced another.

The reason that people generally take medication is that they're prescribed it.  I've already posted a link showing that antidepressants (as an example) benefit 40-60% of people who are prescribed them.  20 - 40% of people benefit from a placebo in place of an antidepressant.  So, roughly half the people who are prescribed antidepressants do not benefit from them . . . and roughly half of the people who antidepressants 'work wonders on' would do just as well with sugar pills.  Then there are the many studies showing that talking to someone about your problem is often about as effective as taking pills for it (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/ for example).

Patients who take pills because they're prescribed them are in a particularly dangerous place if they don't work.  Getting a prescription from a doctor carries with it weight and authority because medicine is a science.  This weight and authority carries over with a prescription from a psychologist . . . but as we've seen, the prescription often won't work.  For someone already depressed, having this faith dashed could carry quite serious consequences.

All that aside for a moment (getting back to the science problem), there is a fundamental issue with something claiming to be science with the goal of returning a person's mental state to normal . . . that is unable to define 'normal'.  It makes it extremely difficult to do meaningful research.  How does one mark a patient in the 'cured' column if there's no definition of what 'cured' means?  It's not possible to validate research, and any research done becomes extremely suspect.  I'm aware that some of the fields in psychology (neuropsychology for example) are improving, creating a model for normal (typically through brain scans and chemical measurement)  and accepting evidence based research now, but it's still a deeply rooted problem for the therapy based side of things.  Until the fundamental problems with psychology are corrected, much of the research done will naturally be limited in what can really be proven.  Right now, much of psychology is at the stage medieval alchemy was at . . . they're poking around aimlessly at stuff they don't understand.  Yes


P.S.  The psychoanalysis that you've claimed "is sh*t" and "is not helpful" has actually been the only therapy shown effective for some anxiety disorders in the clinical trials that you claim to put so much faith in (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623560/).  This of course, is the risk of basing your opinion of something on popular fad rather than on research . . . you find that when research is done, it doesn't always agree with your personal prejudices.  Now, you can certainly argue that since psychology has not proper definition of what normal is that the researchers may have fudged the numbers to support the case they wanted to see - that's a valid concern.  Doing so would invalidate your argument that psychology is a science though.  Bit of a catch-22 you've dug yourself into there.

Regarding the last paragraph: the study you are referring to is certainly not "the only therapy shown effective for some anxiety disorders".
The study is, according to the authors, at the time of publication the first study showing efficacy of a psychoanalytic therapy in an axis 1 anxiety disorder.
Big difference.

Regarding the next paragraph up: the study you referred to is actually a perfect example of a psychological investigation which does not require some elusive definition of normal but simply a measurement of the target variable at different times. In this particular case, a decrease in frequency of panic attacks after the intervention. This type of research always has the characteristic of evaluating with a particular goal in mind, in this case reducing the frequency of panic attacks, and is very common in the applied sciences in general.
The lack of an agreed upon theoretical framework does not make the investigative effort worthless, nor does it equate with groping in the dark. However, one needs to be conscious that the results need to be evaluated within the constraints of functional contextualism, which is the underlying philosophical position with its truth criterion: "if it works it is true within the context"

[FreshPrincess]

I have my own theories on this, but what are yours?  I recognize that within this figure are many who are taking an anti-depressant for an off-label use.

http://time.com/4900248/antidepressants-depression-more-common/

Am i the only person who thought 13% seemed low?  My first thought was "that's it...?"  <shrugs> better living through chemistry.

[cerat0n1a]

About a month ago, I was hanging out with a group of friends over drinks, and in the course of the conversation, the topic turned to antidepressants, and then meds in general. Everyone else at the table was taking at least one medication for a physical and/or mental ailment. So were all of their spouses. I was the only exception. I've never taken anything (other than for a few days if I was ill) except for birth control, my whole adult life. I'm 51. And I am starting to realize just how unusual that is.

I'm in my late forties and we had a similar conversation at a dinner party last week - of the six of us, only one was taking medication on a regular basis (for osteoporosis), but all of our parents were.

Would be interesting to see how the US figures compare with other western nations - Canada would be the most obvious direct comparison. Here in the UK, 5.7% of patients nationwide reported some kind of mental health problem (but only 2.3% with depression or anxiety.) That's significantly higher than 5 years ago. I suspect doctors here are likely to talk about exercise, sleep & diet first and CBT & other talking therapies would generally be recommended before considering medication, so I imagine the numbers regularly prescribed anti-depressants would be lower. Can find figures showing how many anti-depressant drugs were bought, but not how many people used them.

[Yankuba]

I have my own theories on this, but what are yours?  I recognize that within this figure are many who are taking an anti-depressant for an off-label use.

http://time.com/4900248/antidepressants-depression-more-common/

Am i the only person who thought 13% seemed low?  My first thought was "that's it...?"  <shrugs> better living through chemistry.

I thought it was low. Take away the stigma of mental illness and the cost of treatment and I think we can easily hit 20%.

[Thegoblinchief]

Yes, based on people I know and my own experience 13% seems incredibly low.

I’ve been on and off SSRI’s since 18. Finally coming to grips that I really should stay on them, as when I’ve tried going off them, inevitably within about 12 months shit goes into a tailspin.

In my case I’ve had everything from panic attacks, anxiety induced muscle spasms, crushing depression, suicidal thoughts, and manic periods (fun and horribly scary at the same time, honestly scarier than the suicidal periods in many ways). There’s probably a huge genetic component to mine, as my dad and my sister both rely on medications for normal function as well, though my dad really struggled to find a good medication earlier on when so many of the drugs then had awful side effects.

Despite my huge range of intense symptoms, the actual dose I need is very small. One of the smallest you can take of my particular medication. So even very small imbalances can have huge symptoms.

In my personal experience, I *can* survive off meds. I have to be incredibly vigilant about diet, exercise, meditation, etc. The slightest error fucks me up. With meds alone, I can function okay. With meds and the self care elements I’m generally pretty solid though I always have ups and downs. My dad is similar. My sister can straight up not function without meds, and she actually uses two in combination with two different modes of action (one is an SSRI, can’t remember the other type she takes).

[Glenstache]

May you never meet the black dog of depression.

Amen to that. Despite how disrespectful some people are being, I still wouldn't wish depression on anyone.

Yep. +100

Really, the first response to OP nailed it. Clinically, the most effective results are from a combination of therapy and meds. The combo is more effective than either in isolation. I have dealt with major depressive disorder my whole life. I tried therapy-only for years before finally agreeing to try meds. Yes there are side effects, but I wish I had started meds much, much earlier.