Common Explanations for Soaring Antidepressant Use

Nowhere in the CDC report is there any explanation for the 400 percent increase of antidepressant use from 1988 to 2008, however, there are several common explanations offered by mental health professionals and journalists.  

Money is a large factor. It has become more lucrative for psychiatrists and other physicians to prescribe medication than to provide talk therapy. This was detailed in the New York TimesMarch 2011 investigative report “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” which reported, “A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients.” Actually, most antidepressant prescriptions are written by physicians other than psychiatrists and, according to the recent CDC report, among Americans taking one antidepressant, less than one-third of them  have seen a mental health professional in the past year.  

Antidepressant use has also skyrocketed because of the increased practice of prescribing antidepressants for many conditions other than severe depression, and prescribing them for longer periods of time. Among the 2005-2008 antidepressant user group (no data offered on earlier study periods), only 33.9 percent had severe symptoms of depression; 28.4 percent of antidepressant users had moderate symptoms; and 19.2 percent had mild symptoms; while 7.6 percent had no depression symptoms. And, according to the CDC report, more than 60 percent of Americans who are taking antidepressants have taken them for 2 years or longer, with 14 percent having taken them for 10 years or more. 

According to antidepressant manufacturers, the increase in antidepressant use has been caused by their creation of more effective antidepressants, including the so-called selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft which came on the market in the late 1980s and early 1990s. However, by the late 1990s, psychiatry textbooks had already rejected the idea of increased effectiveness of SSRIs (for example, Robert Julien’s A Primer of Drug Action (1998) states, “The newer antidepressants [SSRIs] are not necessarily more effective than the older TCAs [tricyclics] ).” 

Rather than SSRIs’ greater effectiveness, it was their greater publicity that stimulated public acceptance. One publicity coup commenced in 1997 when U.S. government agencies changed the rules for broadcast advertising, no longer requiring full information about side effects (which had previously made it problematic for drug companies to run a thirty-second spot). TV advertising dramatically increased patient requests for antidepressants from their physicians. A study reported in 2005 by the Journal of the American Medical Association, “Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants,” concluded, “Patients’ requests have a profound effect on physician prescribing.” 

A Neglected Explanation: The Depoliticizing of Despair

A largely neglected explanation for the huge growth of antidepressant use is that Americans have increasingly been socialized to equate all states of demoralization and immobilizing despair with a medical condition, and to seek medical treatment rather than political remedies. 

Depression is highly associated with a variety of overwhelming pains, including physical pain, relationship pain (such as a dissatisfying marriage and social isolation), trauma—and financial pains.  

Financial pains include unemployment, poverty, and debt. In 2007 the U.S. Substance Abuse & Mental Health Services Administration reported depression in 12.7 percent of unemployed people compared to 7 percent of employed people. And the Urban Institute in 1996 reported that Americans on public assistance have at least three times higher rate of depression than those not on public assistance. A person who has suffered mental illness is three times more likely to be in debt than someone who is not in debt, according to Richard Wakerall, director of the U.K. mental health organization Mind in Plymouth. 

Recently, I had a chance encounter at Cincinnati’s Findlay Market with five young adults who reported large student-loan debt and who appeared mildly depressed about it. I happened to be in a charged-up mood, having just participated in an Occupy Cincy march, and I told them that the entire U.S. $1 trillion student-loan debt could be forgiven if the U.S. government paid it off rather than funding the damn military-industrial complex, which costs us over $1 trillion a year if you include everything. They started to smile and look more energized, and three of them seemed interested in the Occupy Cincy movement. If America’s millions of depressed student-loan debtors could politicize their despair and take it to the mall in Washington D.C., we could dwarf the crowds in Tahrir Square. 

Can Activism Be an Antidepressant?

Almost as soon as I entered Freedom Plaza in Washington D.C. on October 6, I experienced a wave of pleasant feelings and energy. My wife, Bon, and I showed up about 10am on the first day of “October 2011” (“Occupy Freedom Plaza”) in Washington D.C. after driving there from Cincinnati. In sharp contrast to the blank and depressed faces that I had just seen on the D.C. Metro and on the D.C. streets, we were now surrounded by a thousand or so people who were smiling, laughing, engaged in political discussions, and eagerly awaiting the day’s events. I chatted with two of the organizers, David Swanson and Margaret Flowers, and found their hope and energy a supreme antidote to cynicism. The opposite of depression is vitality, and so by just stepping into Freedom Plaza, I had received a strong antidepressant.  

Then came the day’s major march. Depression is much about feeling hopeless, alienated, isolated, and powerless, and this march was an antidote to all those feelings. For a couple of hours, we felt some real power. We marched on the streets— not the sidewalks—and traffic was blocked by police, who for those moments in time actually were the People’s servants. We marched past the White House and the Treasury, paused at the U.S. Chamber of Commerce to “drop off some job resumes” and for some short speeches, then up and over to K Street, with many cars honking approval and some non-marchers on the sidewalks raising their fists and shouting encouragement. Then back to the Plaza, and a couple of hours later a General Assembly. 

The General Assembly was attended by about 500 people who experienced, some for the first time, a non-hierarchical, anti-authoritarian, respectful democracy where the issues of the day were discussed. No one was rude  and all seemed jovially patient. We hadn’t planned to stay more than that day, but leaving the Plaza late that evening, we had an urge to return. 

The next morning, I found my pace quicken as I headed from the Metro station back to Freedom Plaza, as I was excited to return to this piece of “federal property” that had begun to feel like a “People’s Oasis.” We had succeeded, at least for the time being, in taking back a small piece of the United States and restoring it to some kind of sanity and humanity. A section of the Plaza was filled with sleeping bags, backpacks and cardboard shelters, and our food, media, and first-aid tents still stood.  

We decided to prolong our visit and stay for the afternoon march to the Martin Luther King Memorial. At this march, there were the chants that are common to all Occupy marches: “We are the 99 percent.” “The banks got bailed out, we got sold out.” “Hey, hey, ho, ho, corporate greed has got to go.” “Show me what democracy looks like. This is what democracy looks like.” On this march, we paused at the International Trade Center (in the Ronald Reagan Building), where there were about 75 demonstrators protesting the tar sands pipeline. As some of our marchers had earlier participated in their protest, the pipeline protesters returned the favor by joining our march. We shouted our appreciation and our morale kicked up another notch. 

Leaving Freedom Plaza at the end of my short stint there, I thought that even a little dose of democracy, especially when it has not been experienced, is the best damn antidepressant that many people will ever experience. And even if the cynics are right and the movement dies from cold weather or gets large enough for the corporatocracy to bring out their tanks and crush it, something still will have been won. Everybody who participated will remember that their demoralization and despair was “cured,” at least for a time, not by a pill or any other consumer product but by their own political actions.  

Bruce E. Levine is a clinical psychologist and author of Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite  (Chelsea Green, 2011). His Web site is www.brucelevine.net.