After reading Dr. Jacob Hess‘ post this week, and another he wrote in his own blog Unthinkable, I received an AARP Bulletin that prompted some research on their site. There I found a warning many people who were not even diagnosed with depression were getting prescriptions from their family doctors.

Indeed, the practice of prescribing these drugs without a diagnosis of depression is escalating and more common in men and women over age 50.

Nissa Simon, are Doctors Overprescribing Antidepressants?.  AARP Bulletin, September 20, 2011

In that article, they reported that four of every five prescriptions written for antidepressants, making them the third most commonly prescribed class of drug in the USA, this according to a study published by Health Affairs.¹  Simon also reported: “the practice of prescribing these drugs without a diagnosis of depression is escalating and more common in men and women over age 50.”

Most of these prescriptions were made by a family doctor without clinical evidence of depression, but rather for symptoms of melancholy, headache or tiredness. She stated that most primary care physicians and specialists are not trained in psychiatry, but still they dispense “powerful drugs that may have either no impact or harmful effects.”

In the study she cited, Mojtabai and Olfson found that “between 1996 and 2007, the proportion of visits at which antidepressants were prescribed but no psychiatric diagnoses were noted increased from 59.5 percent to 72.7 percent.”² Worse, these “drugs are effective for a limited number of conditions, including clinical depression, chronic depression, and some anxiety disorders.” In their report, they stated the share of physicians prescribing antidepressants without such a clinical diagnosis increased from 30 percent to more than half of all doctors. “The typical patient who received antidepressants without a formal diagnosis was a white woman over 50 who had high blood pressure, diabetes or several medical problems.”³

Psychiatrist Dilip Jeste, M.D., of the University of California in San Diego, says that “recommending medications for reasons not approved by the Food and Drug Administration, a practice called off-label prescribing, ‘is not illegal, nor is it rare in clinical practice.’ However, ‘antidepressants are powerful drugs and can have a variety of adverse effects, which are more common in older adults with multiple medical problems,’so “the study’s findings are worrisome.”⁴

“It is the aloneness within us made manifest, and it destroys not only connection to others but also the ability to be peacefully alone with oneself.”

Andrew Solomon in his book The Noonday Demon: An Atlas of Depression

Depression is the most common of all mental illnesses and is a “disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life… [and] is caused by a combination of genetic, biological, environmental, and psychological factors.”⁵ While all anti-depressants come with side effects, including gaining weight, problems sleeping, changes in blood pressure, and dizziness, the most frightening is an increase in thoughts of suicide.

It is important to note that depression does not always lead to suicide, but the FDA lists this as their first warning: “In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.”⁶

In our home growing up, the topic of mental health was taboo for discussion, but there was no question our mother was self-medicating to cope with four boys. She was depressed and none of us knew how serious it was until she attempted suicide.

In their study, “Olfson says that people should recognize the difference between the sadness and grief that becomes more common with age and the persistent and distressing pattern of depression that interferes with sleep, appetite and concentration. He advises people to talk over these feelings with a doctor.

“‘Find out if your doctor feels your symptoms fit the definition of clinical depression, and why, and whether medication will help,’ Olfson says. ‘And because antidepressants don’t work immediately, ask how long it will take before you can expect to see a difference.’

“You should be able to take time to talk about these matters with your doctor and not try to rush through the conversation in the course of one hurried 15-minute visit.

“‘This discussion will help you understand your own treatment better so you can recognize if it is or is not working,’ counsels Jeste.”

Luckily I the case of my mother, Iwas a trained US Army Medic and stabilized her until help arrived. But after a few days in the psychiatric ward in our local hospital, she came home. But none one of us knew what to do or say.

It was taboo all over again. I assume she had some follow-up therapy, but we were not included. Worse she was angry with me for saving her. It turned out that I needed help too, I just didn’t know it.

Happily, for our readers, Dr. Jacob Hess is contributing to our blog and podcasts regularly now. In his first podcast, he shares “How Anti-Depressants May be Slowing Down our Healing Process” and in a separate post he explains “Why Have Suicides Increased After Enormous Efforts to Reduce Them?” Those both have helped me and I look foward to his other contributions. For now I hope you find his “Ten Simple Things We Can Do Immediately to Reduce Suicide: A Zero-Cost Public Mental Health Proposal” useful. I know I did.

TEN SIMPLE THINGS WE CAN DO IMMEDIATELY TO REDUCE SUICIDE:

1. STOP telling people that an enduring brain deficiency underlies their emotional /mental distress; most scientists have rejected that hypothesis.
2. START helping people understand what most all neuroscientists and geneticists now know about brain changeability. 
3. STOP telling someone facing a serious mental or emotional distress that he/she will likely have to face it for “the rest of your life”— LEAVE FUTURE POSSIBILITIES OPEN! 
4. START helping people understand the many ways that they can move toward long-term, sustainable healing.
5. STOP insinuating to patients that their mental health condition is somehow reflective of “who they are.”
6. START helping people related to their mental health condition as something workable that are “facing.”
7. STOP pretending willpower, or gratitude diaries, or weekend retreats, or meditative techniques or breakthrough medications will ever have the singular power to make emotions suffering go away.
8. START talking about the many different ways that human beings have learned to work through emotional suffering as a meaningful experience.
9. STOP pressuring people towards one single path of healing.
10. START making (more) space for people to make the right choices for them.

FOOTNOTES

¹ Ramin Mojtabai and Mark Olfson, New Perspectives on Substance Abuse, Health Affairs, vol. 30, no. 8
² ibid.
³ Nissa Simon, Are Doctors Overprescribing Antidepressants?, AARP Bulletin, September 20, 2011 
⁴ ibid.
⁵ Depression, National Institute of Mental Health
⁶ ibid.