As I’ll be out and about for the next few weeks with spotty Internet access it seems as though it is time to turn over the blogging to others. Here then is a guest submission from an anonymous-for-the-moment philosopher queen hailing from the beautiful farm country just north of the Mason-Dixon Line…
In October, the President’s Council on Bioethics (www.bioethics.gov) released a 400+ page report on biotechnology, entitled “Beyond Therapy.” The report rings of Luddism, arguing that our unbridled pursuit of individual happiness in the form of “mood brighteners” (read: Prozac and other SSRI drugs) is turning us into a society of shallowness and solipsism. Psychiatry is transforming into “cosmetic psychopharmacology” (Peter Kramer’s phrase). If we find ourselves unable to mingle well at parties, or we tend toward melodrama thus irritating our companions, doctors now have a diagnosis for us that entitles us to a prescription for little green tablets that will remake us into more congenial and thereby socially rewarded selves. Melancholy is decidedly pass
First off, Peter Kramer is not to be trusted. His book, Listening to Prozac is filled with greatly exaggerated claims. Even proponents of the drugs don’t hold Kramer in high esteem.
About two-thirds of people feel better after they take an antidepressant. Two-thirds of people also feel better after they take a placebo. In other words, antidepressants are glorified placebos. For more information, see this article called, “Is it Prozac? Or Placebo?”, reprinted here from Mother Jones magazine:
Is it Prozac? Or Placebo?
Small chuckles (editor’s note): that world is deprived of drama and history?
“About two-thirds of people feel better after they take an antidepressant. Two-thirds of people also feel better after they take a placebo. In other words, antidepressants are glorified placebos”
This would only be true if they were the exact same people. I know people who couldn’t function at all without antidepressants.
Dave,
Have you tried secretely replacing their antidepressants with sugar pills to see what would happen?
Incidentally, speaking of antidepressants, see this article from yesterday’s New York Times:
http://www.nytimes.com/2004/03/23/health/23DEPR.html
My prediction is that lawsuits will result in antidepressants being taken off the market completely in five to ten years. Trial lawyers were able to bring the tobacco industry to its knees, and they’ll do the same to Big Pharma. Or maybe that’s just my wishful thinking…
Have you ever considered that 70% of SSRI takers are women because women are more in touch with what and how they are feeling than men are? Not that men are shallow and insensitive.
While we’re making generalizations here: Men are generally emotionally less sophisticated, so they are less likely to examine their feelings and conclude anything about them, therefore medicate themselves.
I’m not going to comment specifically on a report I not only haven’t read but hadn’t even heard of until I saw this blog entry, but if the description of the report’s contents is essentially accurate then I think it’s a mistake to equate it with Luddism.
I do know that there are people who really do need antidepressent drugs in order to function…I have more than one such person in my own family. But that doesn’t change the fact that our society _has_ taken to these drugs in a way that’s hard to avoid regarding as sinister, or at least negatively portentious. There’s a significant and important qualitative difference between a debilitating psychiatric disorder like major depression or bipolar disorder, and a socially (or even personally) undesirable mood. But the line that used to be drawn between them is now being blurred by the widespread prescription of SSRIs, especially by general practitioners who are not experienced in diagnosing and treating psychiatric conditions. And I think it’s totally appropriate that some serious scrutiny be addressed to that issue, because the sociological consequences if the trend continues are likely to be profound, and I’d bet against them being good.
Saying that some applications of science and technology have undesirable or even unacceptable consequences does not make one a Luddite.
Matt, I used to agree with you. My position now, however, is perhaps more radical (but, I believe, is consistent the data). I think that the FDA should take antidepressants off the market. At best, these drugs do essentially nothing. At worst, they might make you suicidal or homicidal.
Antidepressants do not work appreciably better than placebos (see the link in my first comment above). The small, statistical superiority of drug over placebo is not clinically significant and is most likely the result of side-effects (people think to themselves, “I have diarrhea, I’m sleepy all the time, I lost interest in sex — wow, this must be one hell of a powerful drug, and I bet that I will soon start to feel better”. This belief then becomes a self-fulfilling prophesy.)
In most cases, antidepressants are not dangerous. Yeah, they can be expensive, and they have annoying side-effects, but only a small fraction of people (thankfully) become violent. The real danger of antidepressants is more subtle, or more insidious. People who take antidepressants are lulled into a false sense of security that prevents them from doing something that might actually work well and have a long-term beneficial effect.
People who are depressed usually have external factors — i.e., things that have nothing to do with neurotransmitters — that are going wrong in their lives.
Depressed people are unemployed or have dead-end jobs; they don’t get along with their loved ones; they don’t exercise; they live on junk-food; they’re deep in debt; they stay up late at night watching sit-com re-runs. Instead of taking measures to do something concrete and practical to improve their lives, these people look for a quick fix in the form of a little pastel capsule they take every morning. And, like I said, about two-thirds of these people do end up feeling better, at least in the short run. But the improvement is often rather minor, and the people are prone to relapses.
So what’s the answer, then? Well, cognitive therapy and interpersonal therapy have been shown to be effective at treating depression. People who undergo these types of therapy are less likely to relapse than people who take drugs alone.
For really severe depression, nothing beats electroconvulsive therapy (ECT). It’s quite unfortunate that movies such as One Flew Over the Cuckoo’s Nest have given this treatment a bad reputation. ECT literally saves lives. See, for example, this article from the BBC website: ECT ‘better than anti-depressants’
For people who are not so depressed that they are incapacitated, common-sense measures are often neglected when devising a treatment plan. There are many specific, rather obvious steps that people can take to improve their outlook on life. Oh, sure, these steps require some effort, but hey — nothing in life is free:
If you’re stuck in an unhappy romantic relationship, either get couples’-counseling or get out of the relationship.
If you currently have no “significant other”, place an advertisement on Match.com or attend some singles events.
Do aerobic exercise at least half an hour a day, five days a week.
Make sure you get enough sleep.
Watch less TV.
If your work situation is making you unhappy, come up with a specific plan for addressing the problem(s).
Don’t isolate yourself. Get involved in social activities. Rekindle old friendships, or make new ones.
Do volunteer work. Feed the homeless, walk dogs at your local animal shelter, or read to the blind. This step is amazingly effective at giving you some much-needed perspective in life.
If you used to engage in a satisfying hobby that you have since neglected, resume your interest. Pick up your old guitar, go out and plant some tomatoes, or dust-off your camera.
Throw out your bags of Doritos and Chips Ahoy cookies. Resolve to improve your eating habits.
What is my interest in all this? When I graduated with my MBA in 1995, I got a job on the marketing team of a major pharmaceutical company. I worked with the company’s antidepressant drug. I spent about three years there. One of my responsibilities was arranging interviews with psychiatrists (and other physicians) to see how they treated depression.
I really had no “inside information” that was damning to the product made by the company that employed me, but the whole experience left me with a profound skepticism of pharmacological approaches to treating mental illness. So much so, that I now write a blog on the subject (and on other, related, topics).
Take More Vacations. Most Americans only have 2 weeks a year, as opposed to Europeans who have a minumum of double that(and often more) and aren’t a drugged up society. Could there be a relationship? I know it gets me down terribly is I go without a good break for too long.
And if it’s money you worry about: buy a European sized car and TV and prepare your food european style: fresh ingedients. (these also have other advantages than just saving money)
Maybe I am stereotypical here, but don’t blame me for starting it! 😉
Oh, one more thing:
I forgot to mention the single-most important common-sense measure to treat depression.
Substance-abuse is very common among depressed people. If you abuse alcohol or drugs, nothing else you do will make any difference. You must stop abusing chemicals if you want to feel better.
OK, I’ll shut up now. Thanks.
Francis Fukuyama, in his book Our Posthuman Future, makes much the same point about the gender effects of antidepressant prescriptions — in fact, he goes one step further by saying (you’ll have to forgive the paraphrase, I can’t put my hand on my copy of the book) that SSRIs give women a neurotransmitter profile closer to a man’s, giving them some of that “alpha male feeling”, and that Ritalin prompts little boys to display behavior in school that’s more like that of little girls (attentive, cooperative); he suggests, wryly, that pharmacology is pointing us toward a unisex future.
Hi, Alex. I’ve read your comments on DB’s Medrants blog and found them interesting. I’m going to say something that isn’t exactly congruent with what you’re saying, but I recognize you as someone who plays fair in debate and wouldn’t strike back with something overly personal.
“Depressed people are unemployed or have dead-end jobs; they don’t get along with their loved ones; they don’t exercise; they live on junk-food; they’re deep in debt; they stay up late at night watching sit-com re-runs. Instead of taking measures to do something concrete and practical to improve their lives, these people look for a quick fix in the form of a little pastel capsule they take every morning.”
Um, this here doesn’t describe me. I’m happily married, I have two children I adore, before my children were born I had a remarkably successful career and now I am building my own business. For seven years I did not own a car and bicycled everywhere, and I participated in a 500 mile bicycle ride across the Rockies; I’m in excellent shape from biking and open-ocean kayaking. My diet is excellent. I don’t abuse drugs, alcohol, or smoke. I have friends and hobbies and I am a volunteer who visits the sick. I have a strong personal religious faith.
Yet, like other members of my family I suffer from periodic depressions. For over a decade I tried to “tough it out” doing the things you recommend, but I still suffered from deep periodic depressions. I didn’t like the idea of antidepressants either, but after my first child was born I read the research regarding cognitive outcomes for children of depressed mothers (not good). It was fine for me and my husband to decide to “tough it out,” but tiny children are just helpless passengers. I decided to swallow my pride and do _whatever it took_ to be the best possible parent I was capable of being.
I certainly take your point about depression being a disease in which behavior (and something you didn’t address, styles of thinking) plays a role, and I have by no means given up on all of the other things I do to both have a life that’s not depressing and to stay healthy. I find that the antidepressant I take helps me to be *able* to give my best effort towards helping myself. I agree with you that many people turn to antidepressants as a cure-all, and that that’s a bad thing. But that’s just not true of all people who take antidepressants. I think you have a good argument, and in a way, a good “sorting” program for those who need antidepressants and who doesn’t (eg, lifestyle modifications first!), but I do think some qualifiers are in order. Adding some “mosts” or “manys” to your statement would strengthen, not weaken, your argument.
Matt wrote:
“There’s a significant and important qualitative difference between a debilitating psychiatric disorder like major depression or bipolar disorder, and a socially (or even personally) undesirable mood.”
Yes, but that’s all it is – a *qualitative* difference. Why should we draw a line where none exists?
Should mildly depressed people be told “Sorry, you’re not quite unhappy enough to warrant a drug. You’ll just have to tough it out”? Who gets to make this distinction? The government, I suppose?
I’ve been on antidepressants for the past 4 months. What prompted the prescription was an acute anxiety attack ,,, while driving. In less than 5 minutes I found myself stumbling out of my Jeep, collapsing in the grass in front of a gas station, and turning from gray to blue. Since taking antidepressants I’ve only had a few minor episodes. Want to talk about a social good? How about antidepressants making the road just a little safer. An example falling into the rule of small numbers, I know. But it illustrates a point – if you’re going to be talking about a social good, you’d better have some experience to back up your opinion.
Lisa,
I’m glad you found relief by taking an antidepressant, and I certainly wouldn’t advise you to stop.
However, I don’t think that it is humanly possible for someone to use introspection to discriminate between a drug’s direct, biochemical effect on the brain, versus an indirect (placebo) effect. If this were possible, we wouldn’t need double-blind, placebo-controlled clinical studies.
(Incidentally, I never suggested toughing it out. I suggested taking measures that I think would obviate the need for toughing it out. Are these measures 100% successful? Certainly not — but nothing is perfect.)
See also: "Most Patients Report Troublesome Side Effects, Modest Improvement Using Current Antidepression Treatments "
Clarification:
I meant that it’s only a *quantitative* difference. There’s no real objective difference between “real” depression and just being in a bad mood.
Alex:
“I’m glad you found relief by taking an antidepressant, and I certainly wouldn’t advise you to stop.”
No, but you’d make it a felony to continue.
I’ve seen antidepressent drugs work in situations that nothing else would touch. And I’ve also seen SSRI users with no previous symptoms of _serious_ depression unexpectedly blow their brains out. The latter type of case invariably involved prescription of the drugs by a GP without either a psychiatric diagnosis or any treatment plan more comprehensive than “here, take these pills and you’ll probably feel better soon”.
it’s sounds grate
Reportedly the proportion of depressed women to men is the same. However the report rate for women is higher for various reasons. A primary factor in lower reporting for men is the social expectations that prohibit men from learning they even have a depressed condition. (A book I’ve read on the subject “I Don’t Want to Talk About It”, by Terrence Real.)
As a person who spent 27 years living with recurrent major depression (and not knowing it) anti-depressants are critical to my ability to sustain myself today.
These grand pundits spinning yarns about the effect of anti-depressants are obviously people who have not suffered with the burden of this invisible illness.