February 28, 2008

The Medicated Americans: Antidepressant Prescriptions on the Rise. "Close to 10 percent of men and women in America are now taking drugs to combat depression. How did a once rare condition become so common?" [Via Mind Hacks.]
posted by homunculus 16 years ago
  • Relatedly, and as discussed on As It Happens last Tuesday, for all cases but the most severe depression, placebos are just as effective as the real stuff, suggesting that the benefit comes from the act of caring than any pharmacological properties.
  • That placebo study is extremely suspicious. I suspect it is complete nonsense.
  • Wow, that's depressing.
  • Dunno, Hank. IANAS, so I can't comment on their methodology, but just the fact that they used Freedom of Information requests to get the drug companies' own unpublished studies from when they were looking for FDA approval -- there's a lot of information made available that wasn't known previously, and those studies must be of a certain quality already. How the meta-study was done, I don't know, but the premise holds promise. And the guy didn't sound like a quack, even if he was only good enough to be hired by the University of Hull*. *Which may actually be a decent school. I have no idea -- I find it hard not to make the association to our own Hull (may it rest in peace).
  • Many years ago I had a bout (more like a hellish year) of General Anxiety Disorder. Once it was diagnosed and identified to me as a known and fairly common disorder, the symptoms gradually disappeared. I never took any meds. I suspect a similar thing is happening to some depression sufferers, except many of them get pills and attribute the effect to them. * That by no way accounts for all cases. The meta-study itself shows SSRIs cause a definite improvement for some patients.
  • I chalk it up to an winner/loser paradigm in US culture, the false god of excessive materialism, the perpetuation of ignorance in the form of organized religion, an amoral way of dealing with other peoples of the world and the Walt Disney Corp. It all adds up to an empty spiritual core as it turns out that the pursuit of the "American Dream™" proves to be an ultimately a futile method for achieving happiness. But I could be wrong.
  • When I hit rock bottom in my own life, I walked into the admitting entrance of the nearest County Hospital with a Psych ward (I had no insurance at the time, one of the things that was depressing me), told them about the vacuum hose in the back seat of my car and how well one end fit on the exhaust pipe and was brought in on a 72-hour hold that I could NOT Britney out of. The first 36 hours I did absolutely nothing. I had never laid still for such a long period of time in my life (and have not since - I don't even remember going to the bathroom). But when I started to stir, the doctors in residence tried some Prozac on me and, well, I was certainly ready, willing and eager for SOMETHING to work, and the 11 days spent voluntarily locked away from the outside world and my life at the time certainly was a big help. But I've been taking the Big P and not 'talking back to it' ever since. I was already on a permanent daily regimen of 4 different meds for my heart and related conditions, so one more pill didn't matter much. I wonder sometimes if it's really helping any, but right now my health plan allows me to get a 3 month supply of the generic version for $10, so until it starts costing me more than $3.33 a month, I'm not messing with the formula. This has been a half-hearted testimonial.
  • The shit works for me. My well meaning friends that suggested I should be drug free changed their minds after experiencing the clean me. I go off once in a while to remind myself what fun a no-stop emotional roller-coaster can be. Pills let me step off safely.
  • Well, as it happens, I've been meaning to come off Effexor for some time, and today spoke to my doc about this. Unexpectedly, he agreed that anti-ds don't work all that well.. for most people. He said basically this was because they are way over prescribed. He said that doctors gave them to people suffering from grief, which he opined is a natural process that is reasonable after a loss, that goes away after a time. Some people were prescribed them even, he said, for pre-menstrual tension or the like, which he said was silly. But for real depression, the unshakable, apparently reasonless misery, the Black Dog, they do work. But not instantly. They can take up to several weeks to kick in. So I'm coming off Effexor gradually. I haven't been miserable for some time. Hopefully I won't throw myself under a train or shoot up a shopping mall or something due to it. ;|
  • That placebo study is extremely suspicious. I suspect it is complete nonsense. Homie posted a fascinating link in the 'defense of Big Pharma' thread that explains why the statements: 1. antidepressants work about the same as placebos and 2. antidepressants still work very well. are not contradictory. What the Media Misses About Antidepressants
  • I knew I had depression long before I ever tried meds. I did therapy, yoga, tried to live healthier etc., all of those things helped...to a point. then I tried meds and they took me the rest of the way to a healthy functional life. Hank, I hope Effexor didnt give you the horrendous nightmares that caused me to go off it!
  • A good point there. SSRI's are not for everybody. A stress related grief is usually not permanent. Hopefully, shouldn't be. They can give you a reference point to get on with life. Some folks just get born with a big, black cloud over their heads. When I'm off, for a while I see the most beautiful storm clouds and bizarre sunrises, but after a while it's only clouds and I gratefully hop back on the train. However, I do keep the dose lowish. The weirdly sad shit gives my writing humour.
  • At least two of my friends have been totally ripped out of their tree by anti-d's. They both subsequently quit them. The celexa guy was eventually like his old (healthy) self again. The effexor guy never really came back.
  • Take my pills, take my life. I don't care if it's placebo or bona fide clinical effect, but those pills are keeping me up. YMMV.
  • Still, aside from those unfortunates who suffer from the Black Dog (I'm not making fun of this at all, BTW) why are so many other people from the most privileged nation in history so unhappy and depressed?
  • "A gramme is better than a damn."
  • kamus, I have always considered that acknowledgment of depression or the time/energy to care/think about/deal with it is something of a luxury of the first world. not to say that people in any circumstances do not or can not experience depression etc., but if you are in a situation where you are merely trying to survive, or not be killed etc., or maybe we are spoiled whiners?
  • This thread makes me want to up my dosage.
  • *hugs PA*
  • I think our isolating society as a lot to do with it. I get the blues sometimes but luckily not capital D depression. And I've come to realize that the blahs usually comes from lack of a good connection to other people. Remember when we were kids and you would just go out with your pals and run around, jump up and down on sofas, throw things around and just *be happy*. That pure elation is what's missing in many people's lives today. i know I was missing it in mine a few years ago, it's better now, but still a ways to go.
  • Remember when we were kids and you would just go out with your pals and run around, jump up and down on sofas, throw things around and just *be happy*. No. There are causes of depression, but even though a lot of them are, they're not all external.
  • definitely many of them are internal Skrik. I feel convinced there is a long thread in my father's side of the family. I suppose I am lucky that mine didn't kick in til 12. I hope you did have some happy moments in yr childhood.
  • I agree that ADs are overprescribed, but I also think they can help the right person a great deal. Mr. meredithea was at a point where he couldn't get out of bed, or even bother to turn the lights on in his room, and the meds turned him back into the grumpy but lovable person he should be.
  • After my lover died (unexpectedly), and I found myself unable to get out of bed, I was forced by friends into seeing both a prescribing psychiatrist and a psychologist. The doctor gave me the max daily dose of zoloft, and the psychologist wanted me to talk about a family history of abuse. Which, as I was grieving, I just wasn't up to. I see the psychologist's point, now, but then it wasn't about confronting history, it was about getting out of bed. So I took the zoloft, and oh boy, did it work. And when I lost my insurance and had to quit it cold turkey later, oh boy, did I feel it. - my anecdotal evidence
  • I tried five different drugs before I found the one that worked. The effects of the other ones ranged from nothing to zombification.
  • I felt guilty when I had my run in with depression. Guilty because I was 21st century American with ZERO real world problems- while others on this earth are in situations so bad I cannot even imagine dealing with. Yet I was "depressed". The guilt just helped the spiral down. I am now on Nortryptaline. Whether it's effects are real or imagined, It helps me sleep through full nights. That alone is a big deal. I could go off it, I think... but why? Maybe me paying big Pharma for my sugar pills is helping them cure Lou Gehrig's disease or something. Right? ehh.
  • *hugs Medusa back* Hugs are a good antidepressant. Plus, you can drink with hugs.
  • *hugs PA as well, and buys her a Blood Shot*
  • I just bought a treadmill and I get more of a mood boost from that than I ever did from antidepressants. Mind you, if I was horribly depressed I wouldn't be able to get out of bed to use it.
  • What truly amazes me is not that some people feel anti-depressants are not for them, or that some people do, but that some people seem to feel they have to stick their damn noses in other people's business. If I say anti-depressants work for me, who the hell are you to disagree and attempt to regulate my behavior? I'm tired of the "put on a smile, hike your shorts up, eat your vegetables, and get on the treadmill" people. As Hank says, exercise is good, but if you CAN'T get out of bed, the treadmill will sit there and rust.
  • Prozac is one antidepressant I refused to even try, because a few people I know had such bad experiences with it, that I knew my fear of the same happening to me wouldn't do my anxiety much good. The fact that lots of other people took it and were fine wasn't enough for me to overcome that.
  • The scary thing about antidepressants is how little we know about how they work - why exactly do they cause an elevated risk of suicide in some people?
  • Ah, now that I'm not in such a grump mood, I'll post something a bit less titchy. TUM, methinks in a decade or three, assuming we don't go to hell in a handbasket first, doctors may be able to test for exactly what type of medication you need. I keep playing around with my meds--turns out the two that are absolutely crucial are Lamictal and thyroid. Other than that, the doc's not sure what's going to work best: You've gotcher Selective serotonin reuptake inhibitors (SSRIs), your Serotonin-norepinephrine reuptake inhibitors (SNRIs), your Noradrenergic and specific serotonergic antidepressants (NASSAs), the Norepinephrine (noradrenaline) reuptake inhibitors (NRIs), and the Norepinephrine-dopamine reuptake inhibitors. I won't touch the Tricyclic antidepressants (TCAs), Monoamine oxidase inhibitor (MAOIs), or Augmenter drugs like Tryptan and Buspar. Everything works differently. Somebody good at guessing might get you closer to what you need, but you're lucky if you can hit the bullseye first time. And then if you're the type that slowly becomes resistant to the drugs effects... A good doc can look at symptoms and suggest something that usually works, but what do you do when the symptoms change? This last horrible bout with depression had an obsessive-compulsive component. That was a new one. I would cheerfully do some cognitive or feedback therapy, but try finding someone here that does it, and then there's the time and the money. Cymbalta has stopped the problem cold in a lot less time that therapy would take. Not to mention I've hashed and rehashed the same old issues over and over. We all have baggage, but the only time my baggage gets to heavy to carry is when I'm in a major depression that doesn't respond to anything but antidepressants. I'd love to not have to take pills--it's a pain in the ass--but if I'm to keep the Black Dog leashed, it has to be with help.
  • *hugs granma*
  • I take an SSRI (Celexa) for another reason. My neurosurgeon gave it to me in combination with Neurontin to help with some horrible phantom pain from spinal nerve damage. He says that nobody seems to know why it works in the brain, but it does. The combo seems to sort of trick the brain into ignoring the pain. Definitely not a placebo effect from that one. If I miss either, or both, I have a horrible acid-on-open-wound-burning sensation in my leg and foot. The added benefit is that I'd be taking it for depression if I weren't taking it for this. It really does make a difference. YMMV.
  • In any discussion of depression, it's important to first draw some clear lines. Clinical depression is a problem resulting from a chemical imbalance, just like thyroid disorders or diabetes. Telling someone to cure clinical depression by cheering up is like telling a diabetic to stop being such a baby and eat that cheesecake, already. Non-clinical depression has a variety of causes, including (but not limited to) grief, personal history, bad relationships, being stuck in an unhappy situation, etc. When offering a critique of depression and/or persons who suffer from depression, please clarify which form you're addressing. You may actually be discussing non-clinical depression, in which case your remarks will be interpreted by sufferers of clinical depression as being those of a total jackass.
  • Mecha, i think that's the crux of the article - namely that the two things *are* being confounded - the clinical and the non-clinical. And that pharms are being prescribed for the latter when they shouldn't be. Is it going to be the norm for people to take a pill to deal with bereavement? I'm asking...don't have an answer.
  • If I have inadvertently made a jackass out myself for any remarks I've made in this thread about depression, I sincerely apologize. I have nothing but empathy for depression sufferers, having been close to a couple of severe sufferers myself and any other impression has been unintentional. I'm not sure if mechagrue was referring to me, indeed if she was even referring to this thread, but looking over my prior remarks I could see in light of the ensuing discussion how they could be seen as insensitive.
  • YES YOU AWFUL PERSON
  • Dammit! I just knew it!
  • So I just went last night to pick up my Celexa prescription, and the pharmacist went all crazy on me because I take Imitrex for migraines. Apparently SSRIs and Triptans have a potential interaction which can cause a toxic Seratonin Syndrome. Damn.
  • Is it going to be the norm for people to take a pill to deal with bereavement? A whiskey pill?
  • Whew! Glad your pharmacist was on the ball there Lara. Sometimes this better living through chemistry stuff can be hard to keep track of. So is that tattoo on a belly or an arm? Hard to tell.
  • Treadmills can get mighty tedious if they don't have a telly, book or laptop nearby. I have a tv in front of mine and still find it very boring.
  • tedium is for people who cannot still their minds. I used to drink on tedium, but I'm learning to still my mind. ..plus I can listen to shtuff on my mp3 player
  • dubnobasswithmyheadman is great on a treadmill. transcendant.
  • Vocalist Karl Hyde provides a monotonous, stream-of-consciousness narrative which, when chopped and rearranged, reveals a quintessentially British reserve that keeps the album mysterious. This is functional music, perfect for driving and, ahem, other repetitive activities. Bwa-ha-ha! *acquires album*
  • I listen to it while cycling on a bike that goes nowhere.
  • Lara, ever tried Neurontin for the nerve damage pain? I took it for years for the same reason -- neck issues in my case -- and it worked really well at a pretty low dose. The only thing I remember being warned off of interaction-wise was antacids.
  • Psychotherapy for All: An Experiment "Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year."
  • hbs, I do take Neurontin, in conjunction with the Celexa. That's the magic cocktail the neurosurgeon recommends. I find it has odd side-effects, so I've asked to have it cut down to the minimum dose I can take and not have the nerve pain. I don't know if it's my particular personality or brain chemistry, but too much Neurontin makes me hyper, and lists of numbers and snippets of songs run through my head without cease until I think I might go crazy. It also messes with fine motor skills to a maddening degree, so I drop and break a lot of stuff, and have some trouble with buttons and the like. But I don't think I'd be able to function normally without it, so it's a godsend.
  • Now that I'm thinking about it, I think I should just drink a couple of gallons of tapwater daily. That might be a boon for all americans who can't afford healthcare. (Don't get me started.)
  • Week 2 coming off Effexor: half previous daily dose. Brain freeze (feels like dizzy feeling when you stand up too quick or blood pressure probs) in late evening if not takey pilly too quicky, but intermittent & passes. This appears to be abating as metabolism adjusts. Due to dose down again by April 5. Crushing depression during night of 7th March (probably related to dying relative, however, or birthday) - no other depressive symptoms. Treadmill & weight training continues apace, some weight loss (4 kilos since last month). Urge to kill not rising. No urge for booze. Slight desire for cannabis (normal). Still amused by goats & walruseses.
  • lists of numbers and snippets of songs run through my head without cease until I think I might go crazy. It also messes with fine motor skills to a maddening degree, so I drop and break a lot of stuff, and have some trouble with buttons and the like. Well that's me on a daily basis and I'm not on any meds yet- a couple more years of parenthood and I'll be ready though.
  • Hommy, that was an interesting article, but where does the wisdom import come in? If you have a chemical depression problem and no way to talk about it, it doesn't just go away. In a society that is very cohesive where families and the whole neighborhood is less alienated from each other, there may be enough of a support system to get you through, but here in the best of all possible worlds, sometimes there isn't anybody.
  • Well, fuck you ladies, so to speak.
  • day 2 of no antidepressants & I feel like I have the worst hangover ever. My head feels like its gonna explode. Not good.
  • Hank, my uncle took himself off of zoloft, and said that it felt like fireworks were going off in his head. I figure you're doing this with your doctor. I wish you luck! Don't be afraid to go back on a little dosage if you're finding things too bad.
  • Hank, I don't know if this will help at this point, but a small dose of prozac (10mg) per day is incredibly helpful in coming off effexor with miminal gruesomeness. I did it last year and it wasn't completely horrible.
  • Are you doing this with a doctor, Hank. Because that is NOT the way they recommend coming off Effexor! My doc wanted me to wean off slowly over a period of a month, and I throughly agreed to it! I learned that the hard way: I'd forgotten my pills when we went horse camping for a week--drove over 200 miles, so we weren't going back for them. At the end of the week, the last 15 mile ride back to camp, I was hanging off the saddle retching and feeling like fireworks were going to take my head off. The neuron excitability is the worst thing about coming off too fast. Do yourself a favor and take it slow, or try the route Medusa suggests (I know nothing about that) Good luck!
  • no, I did it under doctor's supervision. Basically incrementally went down to the lowest dose, then went to see him again, he said "just stop now". So I did. I was prepared for bad side effects, because I had read others' reports, but nothing quite this bad, in terms of feeling ill, I thought it would be a resumption of depression or panic attacks. But I'm not suicidally depressed or anything. Although another bad effect is *very* intense bad dreams. I'm feeling a tad better this morning, but the head still feels a little dizzy. It's like a high blood pressure feeling, that feeling you get if you have vertigo, but like, all the time. But in other news, I immediately dropped 5 kilos this week after coming off 'em.
  • I doubt if I'll try Medusa's suggestion because I don't want any more of this shit in my system.
  • Actually, you know what? I still feel like shit. /heads to bed
  • Hang in there, Hank.
  • Chin up, our Hank.
  • *sends virtual herds of goats & walruses to Hank's doorstep* Monkeyfilter: cycling on a bike that goes nowhere And yes, dubnobasswithmyheadman ftw
  • Good luck Hank.
  • Hope you feel better soon, Mr. Hankie. Congrats on the weight loss. The 10 lbs. that Lupron gave me? I still have them >:(
  • Rootin' for you here, too, HM. Fingers, toes and internal organs crossed that all goes well.
  • I don't see what the fuss is about. I feel a little shit, is all. Nothing's gonna happen, I'll be alright in a few days. Maybe it will take a week, I can't see it taking that long. Thanks, though. Oh, I could do without the dreams about werewolves and bigfoot.
  • I should add I was a little inaccurate, it was day 3 where I wrote day 2 above, but the symptoms of withdrawal didn't start until a day after stopping. Weight loss has been since Monday, which may be due to being in bed and not eating much, or to the Shangri-La diet which I just started, which seems to really work to stop hunger cravings. But I have started losing weight since before that (I bought a treadmill recently) but just not as dramatically. And I haven't been exercising this week, because quite frankly even standing up suddenly is a bit of a sickener, let alone exerting effort on anything. I think my brain's a little foggy, but that might be because of the ZAP ZAP ZAP electrical kind of effect that seems to be happening in the skull every now and again, perhaps that's what people mean by fireworks.
  • Yup, that's it. Zap ZAP ZAP! Gotta love it. If you've never experienced it (and you don't want to) then you can't imagine it. But I double-D damn guarantee you don't forget it if you do. Great stuff, eh, Hanks? Think about trotting on a horse with that going on. Good times.
  • I dunno how the hell you managed to do it. All I could manage the last few days is lay in bed. YOu is tough sheilar. Bit better today, but still getting the odd ZAP ZAP ZAP. Just had some then. But feeling a tad better. I've found myself forgetting how to spell simple words. This is a disturbing side effect.
  • No worries mate. In a couple days, it will come back to you. Just an overstimulated and insulted nervous system. Although, when it appears to be over, sometimes if you get too tired or do some heavy physical move suddenly, you may get a zap. It does eventually go away though.
  • Hank, I'm talking off the top of my head here so just ignore this if I'm out of line. That weight loss, i first thought was five pounds, but you wrote five kilos - that's ten pounds in a week. IANAD, but that sounds bad to me.
  • The weight loss is hardly noticeable. It doesn't amount to anything dramatic, as far as I can see. And I am overweight, I am 90+ KG (91.8kg today) which is about 203-4 pounds, and at 5'11" that is way over. I need to lose about 20kg. Losing 5 kg a week is not dangerous, I think. This week I've been flaked out cos of coming off these antidepressants, so I lost a bit more. I'll eat some ice cream and apple crumble today just to offset anything worrisome. I'm taking vitamins, so there should be no problems with nutrition. I'm gonna have a roast in a minute. So we're not talking scary lack of eating. It may be loss of weight due to no more fluid retention or whatnot caused by Effexor. Oh, the dreams! I've had being attacked by werewolf, stuck in an alien spaceship, stalked by bigfoot, and last night, the classic: insects under the skin! I don't think I'm going crazy, though. /twitch But I feel considerably better today. I think its wearing off.
  • The roast should fix things pretty quick :). I had a friend who lost a lot of weight in a short period of time and she ended up with gall bladder disease because of the rapid loss. Something I didn't know about before... Hey, those are some scary sounding dreams. I had one last night where I had been selected for a mission on the space shuttle. I was scared crapless so I insisted on having a crew of 100 because that way there would be safety in numbers. Good to hear you're better Hank!
  • Hank, you should start a Curious George thread "has anyone had a stranger dream than Hank"? Sure to be good for 100 comments. Personally, last night I was helping George Bush move furniture out of the oval office, discussing what ex-presidents do, but could only remember Jimmy Carter as an example. Then he turned into my ex-boss from London who had a similar desk. Well it made sense at the time.
  • I dreamt last night that it was opening night of my play, and I discovered there had been a fourth act I didn't know about because the pages were stuck together,
  • I've had manuscripts like that.
  • If I were to describe to you all the particular dream that decided me to stop effexor...oh my. I have only told a few people ever, and they were pretty horrified... let's just say that sex work + my internal organs outside of my body + fecal matter != a happy night ugh!
  • Yeah, but with THAT tagline you have gained immortality: MonkeyFilter: let's just say that sex work + my internal organs outside of my body + fecal matter != a happy night
  • And I thought the space shuttle launch was scary...