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Departing from the tidy premise that depression is a chemical imbalance to be corrected with antidepressant drugs, our society's main response to the growing epidemic of depression has been the pill bottle. It isn't working.
Depression's toll has only risen with the ascendance of antidepressants. The World Health Organization projects that by 2030, the amount of disability and life lost due to depression will be greater than that from war, accidents, cancer, stroke, or any other health condition besides heart disease.
Over time, the tendency to prescribe, and yes, overprescribe has deepened.
For instance, between 1996 and 2005, the overall annual rate of antidepressant treatment among persons 6 years and older soared dramatically --to 1 of every 10 persons in the United States. This translates to 250 million prescriptions a year, with antidepressants the most prescribed drug class for people aged 18 to 45. These statistics evidence staggeringly high antidepressant prescription rates.
This overprescription has many sources. One driver is money. A recent study revealed that pharmaceutical companies spent 5 billion dollars on direct to consumer advertising on antidepressants in a single year. Another driver is who is writing the scripts. Our best data indicates that only 20 percent of antidepressant prescriptions are written by psychiatrists – a huge volume, and certainly the majority of prescriptions, are written by professionals who have little specialized training in mental health.
A third driver is sometimes indiscriminate prescription practicies. One in six people who receive antidepressants do not have depression, nor do they have any other psychiatric diagnosis. Another large study found that only a minority of people who had been told by their clinician that they suffered from depression actually met full criteria for the diagnosis when they were carefully assessed. Nearly 80 percent of this group was prescribed a psychiatric medication. These data show patterns where real-world assessments of depression are cursory and drug prescription verges on the indiscriminate.
Many times before, I have objected to the overprescription of antidepressants and called for a more nuanced, multi-dimensional response to the depression epidemic.
Today, a thoughtful editorial in the New York Times made me consider a new reason for concern about the overprescription of antidepressants: The drugs are provided disproprotionately to females and may be suppressing women's natural emotionality.
The author, Dr. Julie Holland, a female psychiatrist, writes,
"Women’s emotionality is a sign of health, not disease; it is a source of power. But we are under constant pressure to restrain our emotional lives. We have been taught to apologize for our tears, to suppress our anger and to fear being called hysterical.
The pharmaceutical industry plays on that fear, targeting women in a barrage of advertising on daytime talk shows and in magazines."
The result: "At least one in four women in America now takes a psychiatric medication, compared with one in seven men."
Some of these antidepressant prescriptions clearly are legitimate, and necessary, but it is worrying that women are disproportionately encouraged to seek "chemical assistance." Clinically, Dr. Holland worries that the most common antidepressants blunt women's sex drive, as well as diminishing the capacity for negative emotion. She also worries that once they are put on this path, women may be directed away from finding the true sources of their moods.
People who don’t really need these drugs are trying to medicate a normal reaction to an unnatural set of stressors: lives without nearly enough sleep, sunshine, nutrients, movement and eye contact, which is crucial to us as social primates.
Is the disproportionate prescription of antidepressants to women sexist? I don't believe it's intentionally sexist. But these prescription patterns are misguided, and they certainly raise the possibility of unintentional sexism.
If we needed another reason to encourage a more focused, discriminate, and laser-like use of antidepressants, we now have one.
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Jonathan Rottenberg is the author of The Depths: The Evolutionary Origins of the Depression Epidemic. Follow Jon on Twitter.
