Is the US an overmedicated Prozac nation? Or are those who think so overopinionated?

[BurtWorm]

If you think the former, read this essay by Judith Warner and think again:


http://warner.blogs.nytimes.com/2008/02/14/overselling-overmedication/




Overselling Overmedication

...The notion that American children and adults are being over-diagnosed and overmedicated for exaggerated or even fictitious mental disorders has now become one of the defining tropes of our era.

This storyline persists despite the fact that government research has repeatedly shown that most adults and children with mental health issues don’t get the specialized help that they need. It persists despite the fact that there’s really no way to meaningfully evaluate the degree of over-diagnosis and medication unique to our era, because to do so is essentially to look at the current era in a vacuum. We don’t know how many adults suffered from things like depression in the distant past because no one ever asked. The words and concepts through which we understand common mental health disorders today didn’t exist until the last few decades.

The narrative survives largely uncontested despite the fact, shared by psychiatrist Peter Kramer in his Slate review of Barber’s book, that only tiny numbers of people are receiving mental health services without real, clinical levels of mental health dysfunction or a history of mental illness or trauma. And despite the fact that, contrary to received wisdom, the United States is not a world leader when it comes to the use of psychiatric medications. (The U.S. is “’in the middle’ relative to other countries, and is not an outlier,” a study from M.I.T’s. Sloan School of Management, cited by Kramer, showed last year.)

Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon.

...

And what if, examined in the light of basic facts, and with a perturbing bit of common sense thrown into the mix, the popular storyline of our fatal corruption by Big Pharma turns out to be, if not utterly baseless, then at least greatly exaggerated?

Kramer, the author of the 1993 bestseller “Listening to Prozac” and, more recently, “Freud: Inventor of the Modern Mind” and “Against Depression,” makes a quite compelling case in his Slate review that the received wisdom about psychiatric drug use today is ahistorical, narrow in its cultural understanding and factually, often wrong.

...

[ixion]

1. Prozac and Xanex gulping, SUV drivin' morons seems to be the status quo

at least from where I stand.

They'll throw you in prison for smoking a joint, but it's apparently a-okay to throw down a handful of Prozac, hop in your SUV and fire up the cell phone, and drive around without a thought in your head. :eyes: :puke:

[spoony]

7. What any of those things have to do with each other

is a total mystery to anyone outside of your thought processes.

[orleans]

11. not true. i got the point. and i agree. n/t

[spoony]

16. That people on Prozac are self-absorbed yuppies?

I'm lost, please explain.

[orleans]

20. that taking Prozac and Xanex is as common/popular/frequent

and socially acceptable as driving suvs

and

which is more likely to cause harm or create an accident?
1. someone smoking dope
or
2. someone zoned out on prozac while being distracted by talking on a cell phone while driving, while operating heavy equipment (the suv)


and the irony is that #1 is illegal and can land you in jail
while #2 is socially acceptable, far more hazardous to self and others and legal

(although i was amused with the way you phrased your post #7 i had to disagree because i see this frequently in suburbia. it's not a yuppie thing imo though. and after i heard mike malloy talking about how he reacted to prozac tonight--it was exactly that--driving around without a thought in your head--it messes with the affect of a lot of people--mind numbing, no emotion)

[spoony]

21. Have any personal experience?

I do, and that "mind numbing" nonsense is just crap. Or perhaps you have some statistics about people on anti-depressants causing accidents? Otherwise you're just spreading ignorance.

[orleans]

24. maybe it's crap to YOU but it isn't crap to everyone who has used it/them

i said "it messes with the affect of a lot of people"

why so defensive?

i didn't say it fucks everyone up did i?

my purpose wasn't to get into a pissing contest with you about anti-depressants--i thought (stupidly) that you actually didn't understand what the other poster was saying. so i gave you my understanding of it. that's not what you wanted at all. is it?

re: your personal experience. i'm glad it's all good for you.
re: my personal experience with anti-depressants. it didn't last too long. i was so fucking zoned out on that shit i couldn't get up off the couch (the only accident i had with it was going to doctor that didn't know shit about the drug/dosage and my mistake taking it). however, my friend was on prozac for months and months and i saw him disappearing before my eyes. how many accidents did he have? two. that i'm aware of.

just because it didn't effect you in a negative manner doesn't mean everyone has such good luck with it.

are there statistics for accidents that record what meds a driver uses? if you find them let me know.

[spoony]

26. My apologies for the tone

However too often DU threads about medicine, whether it be vaccines or drugs, dwell on conjecture and negativity and these are serious matters. God forbid someone reading them is scared off seeking help because of hype or bad experiences. You had a shit doctor and I don't know what happened to your friend but plenty of people see their loved ones come BACK from the dark rather than lose them to it when they go on these drugs. And yet here I've seen them blamed for mass shootings and national complacency and all manner of unprovable, and in my opinion irresponsible, speculation (such as about auto accidents, which started this).

[BurtWorm]

27. No dope-smokers are on Prozac? No dope-smokers are yuppies?

No dope-smokers drive SUVs while using a cellphone?

:wtf:

[El Pinko]

2. I think it's some of both.

Clearly there are people with severe mental disorders and devastating clinical depression who are greatly helped by medication.


But I also think that Adderol etc. has become a first resort in many cases for ADHD, and anti-depressants are probably more freely prescribed than they ought to be.


It would be great if all people would try natural ways of dealing with manageable levels of dysfunction before turning to the doctor for a magic pill, but the fact is that that's exactly what a lot of people expect.


My older son showed some ADHD-like symptoms in early elementary school, and I'm quite certain that any doctor would have been happy to prescribe him medication, but we changed all of our diets for the better and worked intensively with him every night to help him gain confidence and better study habits and he's doing much better in school now. I'm sure there are kids who really need medication, but I seriously doubt that every single one of the MILLIONS of kids being given Ritalin, etc. really need it or that none of them could be helped with better nutrition and guidance/training.

I know this is a controversial subject, but I really don't think it's as black and white as people make it. Many people who shouldn't be medicated are, and millions of people's lives are greatly improved by medication, too.

My only hope is that doctors will exercise the utmost discretion in prescribing these psychoactive drugs and that patients will try everything before turning to chemical panaceas.

[marions ghost]

3. what bothers me

is the way anti-depressants are not monitored well enough and people are not encouraged or supported to get off of them.

I have a friend who experienced a severe trauma and anti-depressants did help her get over it. They definitely have their place for relief from sudden emotional pain and suffering, as well as for more chronic depression. But the event was eight years ago now and my friend is on an emotional roller coaster with various anti-depressants. Her personality is changed. If her drugs aren't working well enough she is angry, cantankerous and basically non-functional. She has been in trouble more than once for inappropriate behavior stemming from drug use. She has lost friends and family because she uses the drugs to deal with all problems. She does not believe we were meant to feel ANY pain. When I told her one of my relatives had suffered with his cancer toward the end, she was outraged and insisted that the drugs should have covered it. It is clear that my friend is now using anti-depressants to deal with all of her current problems, many of which used to be called just "life."

[BurtWorm]

4. Severe trauma can fuck people up for life.

Look at PTSD. Your friend's life is not what it was and probably wouldn't be even if she weren't on drugs.

[marions ghost]

10. I'm very aware of that

and have had treatment for PTSD myself (from a life-altering natural disaster 10 years ago).

But I don't buy that people always need to be medicated for life because of one event. What I'm saying is there is not much encouragement (or support) for those who might be able to get off drugs in this country. In the case of my friend there has been absolutely none that I can see and I have been very close to the situation for over 8 years. Also my elderly father was over-medicated for many years for anxiety and when the medication was finally lowered by a different doctor he became a completely different person--full of energy--he can actually complete goals and projects that formerly were beyond him. It's like a late blooming. Everybody notices the change in him.

In my friend over time I have seen how the dependency on drugs has compounded her problems. She is subject to fits of anger and rage, she has caused damage with people because she refuses to take any responsibility for her inappropriate behavior, she has retreated to a world where everything must be perfect and fine and wonderful ALL the time. I should also say that this is a smart, talented, creative, and in many ways a kind and good individual. But I do believe the longterm dependency on these drugs has messed her up. Of course anti-depressants might not have this damaging an effect on others. Everyone is different, but what I'm saying is that there is not enough help for those who might be best off without these powerful drugs.

[kineneb]

12. actually sounds like your friend needs different meds

anger and rage are sometimes indicators of poorly/untreated depression. Not all of those who suffer with depression are immobile, hiding under the bed types. Before I was put on my medication, I was almost intolerable; Hubby called that personality "The bitch from hell". All I knew was that every little difficulty would set me off, as if my senses were all raw.

The best treatment for mood disorders is a combination of medications and talk therapy.

[marions ghost]

15. I totally agree that

"the best combination for mood disorders is a combination of medications and talk therapy."

The problem is, in the case of my friend, she has never had talk therapy for the entire 8 years she has been on medications. Talk therapy is expensive but she has insurance and would only have a small co-pay. From talking to her I get that she hasn't asked for it and it hasn't been advocated by any doctor she has seen.

Yes there are different types of depression which makes it difficult to treat sometimes. I suspect because there's not much monitoring with my friend it could be a case as you say of being "poorly treated." I'm glad you found a course of dealing with your situation that works. I wish I could say the same for my friend. :)

[havocmom]

17. even the right meds for an individual are not much help without good cognitive therapy too

The saddest thing is we have a culture where too many patients and practitioners think the sole answer to any problem is a prescription that just makes symptoms less annoying.

Lots of psycho-active drugs being dispensed without enough monitoring and mentoring.

The wrong meds are bad enough. Meds without work being done to improve coping/thinking skills is just one more way to avoid real mental health care.

That therapy part you mention gets missed way too often.

[EFerrari]

5. We can't know. Because prescribing docs do not monitor

their patients well enough. I give them a "D".

[BurtWorm]

6. All I know is

mine monitors me. I see him every other month. He's available all the time if needed.

I don't know how other people's doctors are.

[EFerrari]

8. Doug had six or seven docs in 12 years and all but two were

anywhere from dismal ---> dangerous.

I've had my share of not great experiences with the three people I saw in the last 20 years. Finding a good prescribing doc is like finding gold.

If you think about it, once a person is stabilized on a course of meds, every other month works fine. It's the going on the meds, times when they have to be adjusted or switched out that require skill and attention, and over time, not just that one office visit but for days and even weeks after that.

[BurtWorm]

13. OT: Gosh, you have a lot of hearts there.

:wow:

Back on topic: My wife is now going on meds and having some difficulty finding the right match for her. Her doc sees her about once every three week or sooner if it's urgent. I don't know if this is or isn't typical.

It's maybe a little too easy to think we can project our own experience into the populace at large, but each of us is just one drop in the river. There is, however, evidence that the US is not the Prozac nation it can seem like, which is the point of this essay, and I think it's well taken. There isn't strong evidence to back up the claim that people who shouldn't be on meds are on them, that the nation is being drugged into apathy. I think her point--and Peter Kramer's and mine, as well--is that the anti-medication bias is exactly that--a bias, and not necessarily one based on good information.

[EFerrari]

14. I agree with that. It's much more likely for people to avoid meds

because they can't afford them or because they have problems with them in some way that is never attended to and give up or because they are so browbeaten about NEEDING medical care that they don't go there in the first place.

(As to the hearts, all I can say is DU is a very generous and patient community, our flamewars notwithstanding. And, please make it stop! :grouphug:)

[spoony]

19. "the anti-medication bias is exactly that--a bias"

Hear hear. I find it very disheartening that people seem to think of those on medications as zombies or brainwashed by some big-pharma-government conspiracy or, lately, a ticking time bomb leading to a mass shooting. My best to your wife, and a toast to living in a time when such help, albeit imperfect, exists.

[DaveJ]

9. Not just prescriptions...

Don't forget all the sodas, energy drinks, other types of mood altering food and drugs items sold over the counter. Food is becoming more and more artificial. My theory is that with all the chemicals being used to make food, I wouldn't be surprised if at some point they can be used to alter the population's behavior overall. And who controls the chemicals being put into our food?

[dysfunctional press]

18. people who think the country is over-medicated need to take a chill pill.

nt

[Quantess]

22. Yes, antidepressants are glad-handed out like candy canes at Christmas,

Yet, counseling is hard to come by. The most valuable part of treatment for depression is talking to a qualified therapist, yet, that's the elusive, expensive part for low-income people. I'm currently depressed, and I have been in the past. I know that talking to a good counselor is what has helped me the most. I have taken Zoloft, which was pretty helpful, and not addictive at all.

The drugs are helpful to a degree, but they can be addictive, such as Effexor-XR. My current dosage of Effexor-XR is 37.5 mg, which is a very low dosage. I'm almost over it! The way Effexor was prescribed to me...I told my doctor about my very real depression, then my physician gave me a bunch of free samples of Effexor-XR, and prescribed it to me. I became physically addicted to it. I'm not saying the drug didn't help me feel better---it really did---, but, it was extremely uncomfortable to miss a dose. Reducing the dosage was difficult and uncomfortable. I'm down to half a dose, and I will feel free when I am not addicted to Effexor-XR anymore. I am almost there!

If I had known how addictive Effexor XR was, I would never have taken it!

[Kitty Herder]

23. I had withdrawals from Effexor as well.

It was hell coming off it. They tell us these anti-depressants aren't addictive. But so many people have had withdrawal symptoms when they've stopped taking them.

I went off the Effexor carefully, was weaned off it slowly with help from my doctor. Still, when I finally quit taking it completely, I had serious withdrawal symptoms. SEVERE irritability, crawling sensations on my skin, and even a minor hallucinatory episode. I've never experienced anything like that before or since and it scared the crap out of me. I will never take an antidepressant again. It didn't even help with the depression. AT ALL.

It's not the kind of addiction where you crave the substance and want more of it. Not at all. And once you're off it and the withdrawals are over, you don't have any desire to start taking it again. But if it causes withdrawal symptoms when you stop, I would say it's physically addictive.

I think there needs to be more research into these drugs. INDEPENDENT research. Not only is there evidence of these drugs causing serious harm, such as an increase in suicidality, there is now evidence that their effectivness has been exaggerated. Here's an article about that.

http://www.nlm.nih.gov/medlineplus/news/fullstory_60100.html

[Quantess]

25. "It's not the kind of addiction where you crave the substance and want more of it. Not at all."

Exactly. It's insidious that way. Effexor-XR gets you hooked before you know it. I'm sure Wyeth is pleased. Wyeth gives out samples to doctors, and encourages doctors to prescribe Effexor-XR.

Missing a dose is like "brain shivers", or like mild electric shocks. It's horrible.

Sorry, but Big Pharmaceuticals rule this country. It's a little late for anything to be done about it, besides self-education.