A near 400 percent increase in antidepressant use among Americans makes it hard to argue that the drugs are under-utilized.
But that's the buried and, some say, more troubling finding from a new study from the Centers for Disease Control and Prevention.
The big story last week was that 11 percent of Americans ages 12 and older take antidepressants, as do nearly one-fourth of women in their 40s and 50s. The research was based on responses from about 12,000 people between 2005 and 2008, said study author Laura Pratt.
Theories about sky-high use are many. On the positive side, many see the stigma around depression lessening, which makes seeking help easier. Also, some newer drugs, called SSRIs, promise fewer side effects for treating depression.
On the other hand, aggressive marketing by drug companies, while obvious, may not be the biggest concern. About 75 percent of antidepressants are dispensed by already overworked primary care physicians scrambling to keep up with drugs' complexities.
But it's not high usage that most worries Pratt. It's low usage. Her study also found that only one-third of people with severe depression are getting the medication and treatment they need. Many are young, poor or minorities.
"A lot of things keep people from being treated," said Pratt, an epidemiologist. "Maybe they think they can get over it by themselves, or that medication doesn't work."
Lack of access, though, is a huge barrier.
"A lot of new drugs are outrageously expensive and frequently not covered by insurance," said Eduardo Colon, a psychiatrist at Hennepin County Medical Center. "Other people don't have insurance, period."
That means more people with serious mental health issues are accessing the health care system through the emergency room door, he said. "A lot more people are coming in due to overdoses, suicide attempts or mental health issues who are not receiving regular mental health care," Colon said.
Despite these challenges, Sue Abderholden is concerned that the study's sexier take-away message still will be about over-medication. "There may be some people taking antidepressants who don't need it for lower-level symptoms," said Abderholden, executive director of the National Alliance on Mental Illness of Minnesota (www.namihelps.org). "But we do know these drugs can be effective in people with serious depression."
Abderholden is not, however, alarmed by the high number of mid-life women taking antidepressants. "These are years of pretty dramatic physical changes in our bodies," she said. "Hormones have a huge impact."
Women are, in fact, twice as likely as men to develop depression. "We're not really sure why that is," said psychiatrist Karen Dickson, former president of the Minnesota Psychiatric Society.
"It could be that women deal with stress differently. Their kids are not fully launched, their aging parents really need them and the economy is horrible. It's clearly driving up mental health visits for anxiety and depression." Hormonal factors also play a role, she said.
Homeopathic practitioner Debra Sax Annes agrees that standards and stresses for mid-life women are high today. While not unilaterally opposed to antidepressants, she worries about their limitations and long-term side-effects. Homeopathy, she said, looks at people as unique. "Each depression is different," she said. "Post-partum depression is totally different than the loss of your mother or the loss of a job. We all get stuck with what life sometimes throws us. Homeopathy uses remedies in minute doses to keep people balanced mentally, emotionally and physically."
Dickson also helps women regain their balance. With an acute event, such as a death or divorce, she might recommend temporary use of an antidepressant, coupled with therapy, meditation, diet and exercise, and better sleep. For women experiencing more than two depressive episodes perhaps not connected to an immediate stressor, long-term maintenance with an antidepressant may be warranted, she said.
Sheila, in her 40s and the mother of two young kids, has taken Prozac for more than a decade. One of her three siblings is on another antidepressant, as is her mother. Last fall, she took a hiatus but went back on her medication a few months later. "If it can help you, take it. That's my philosophy," said Sheila, who wanted only her first name used. "I'm a better version of myself when I'm on it."
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