Caution: addiction ahead
DRUG BUST by Alan Cassels
• Why are so many women taking antidepressants and what does this say about one of medicine’s biggest questions? It’s a problem that’s been growing for decades and shows very few signs of improving. Let’s strip this issue down to a few bare essentials.
Q: So what is the problem?
A: For some reason, people in Canada are taking a ton of antidepressants, especially women. If you know four women between the ages of 25 and 55, on average, one of them will be on an antidepressant. That’s right; 25% of working age women will be taking a drug like Prozac, Zoloft, Paxil, Effexor or Cymbalta. Overall, about one in 10 Canadians are taking antidepressants, making Canadians the third highest consumers of antidepressants in the world. The growth in the use of antidepressants has escalated so much over the last 20 years it begs us to ask why.
Q: Is there any easy answer to this?
A: It comes down to how prevalent we think mental illness is among women. I’m thinking of the diagnosis of clinical depression, the key reason these drugs are prescribed. Let’s be clear; for many, life can be stressful and difficult, especially those facing serious challenges, including harassment, violence, economic distress, helplessness, isolation or having grown up in a climate of fear or abuse. For many women – and I will focus on women – there are also the stresses of normal family life in juggling careers, relationships, children and aging parents. It’s clear we need effective ways to help those who feel life’s burden is just too heavy. Even though the drugs – the SSRIs and SNRIs mentioned above – are designed for people with serious clinical depression, they seemingly get used for everyone who is distressed and having trouble coping.
Q: Why is that?
A: This is a complex question. Part of it, certainly, has to do with the way the pharmaceutical industry has marketized and characterized both the disease and the drugs. For example, in Japan, after the introduction of SSRI medications in 1999, the word for clinical depression, “utsubyou,” was dumped in favour of the term “kokoro no kaze,” which literally means “a cold of the soul.” This simple renaming of the disease – equating depression with the common cold – dropped it to the lowest common denominator, absolutely exploding the antidepressant market in Japan. Similarly, “depression” was recharacterized in the Western world in the early 1990s by the drug companies – and their helpful ‘partners’ in psychiatry – who saw it as a “deficiency state” and proposed the solution: a drug to raise a patient’s serotonin levels. This idea that depression is a “chemical imbalance” is a theory that has never been proven though it has gained traction by implying that depressed people are chemically deficient, akin to diabetics who lack insulin.
Q: But these drugs are still widely prescribed and people seem to think they need them. Why?
A: That also needs unpacking. If you are told you have an illness, the only solution proposed is to “see your doctor.” Every day, Canadian doctors face patients with emotional problems. A generation ago, they would have been prescribed barbiturates or anti-anxiety drugs like Valium or Ativan yet the main flavour today just happens to be SSRI antidepressants. If you’ve lost your job, your spouse or a loved one, it is normal to feel sad and “depressed.” If you can still function, most of the research shows your symptoms will typically go away on their own with family support and some professional counselling. But if your emotional state is due to isolation and loneliness, shouldn’t it be a ‘social’ solution you need? We do ourselves incredible harm when we discount the incredible health benefits of meaningful work, good friends and a community of people who love and care for us.
Q: Is it really that simple?
A: Almost. But sometimes people are in crisis. Again, the “see your doctor” plan seems the only game in town even if diving straight for the chemical ‘cure’ – while convenient and simple – is possibly the wrong thing to do. For some with serious depression, however, the pill might help ease the symptoms. Certainly, the attention and care of a sympathetic physician who assures you “you will get through this” is often all that’s needed. Many of us feel a prescription validates our illness. I know many people will swear by the drugs, telling themselves they couldn’t live without them, but the placebo effect is powerful medicine; a large body of research has shown that the placebo effect is as effective as antidepressants in helping relieve symptoms.
Q: But let’s get back to the reason so many people, especially women, are taking antidepressants. What else is going on?
A: The simple answer – let’s call this Alan’s punch line – is that some drugs are very difficult to stop once they’ve been started. Since SSRIs work by stimulating the serotonin system, they can lead to anxiety, agitation, thinking about suicide and even greater depression. The main issue is if you’ve been on the drugs for a while and want to quit, well, let’s just say you’re likely in for a ride. No one should ever try to stop taking an SSRI immediately because stopping suddenly is hell for many people. Stopping abruptly can cause symptoms to come back with a vengeance, causing many people incredible withdrawal effects including the electric ‘zaps’ that seem to jolt you so horrifically it’s easier just to go back on the pill.
Sometimes, people will be prescribed even heavier medication when their withdrawal symptoms are bad, probably the exact opposite of what they need. The key reason people stay on these drugs so long is that they tried to stop and the withdrawal was so dreadful they kept taking them. If you want to stop taking an antidepressant, Google CWHN and “no quick fix.”
Q: Alan Cassels, you’re not a doctor but if you were, what would you suggest for what is termed “mild to moderate” depression?
A: An excellent question and you’re right; I won’t dispense medical advice. Yet as a researcher I know there are many non-drug alternatives that work for many people. Talk therapy works, as does vigorous exercise, which is probably the first thing you should try if you’ve reached the point where you’re seeking medical advice for depression. And exercise can be free. Walking, cycling, running or dancing – anything that gets your blood moving fast and your heart working – will benefit every system in the body, improving mood, sleep, energy and general fitness. Those effects last longer, don’t come with the many adverse effects of SSRIs and are more sustainable over the long term. The good thing about exercise is that while it may also be addictive, this kind of addiction can lead only in the right direction.
Q: I want to know more. Where can I go for more information?
A: I’d start with the Canadian Women’s Health Network, the best-quality, home-grown institution we’ve got, driven by women who know the science and can see through the pharmaceutical industry’s spin. The CWHN has probably the highest quality information about women and antidepressants in Canada, if not the world. Unfortunately, last year their funding was cut by the Harper government, but their site at www.whp-apsf.ca is still operating. If you find their information useful, I would strongly urge you to make a donation. A big one. You also have to check out Robert Whitaker’s work and his “Mad in America” website (www.madinamerica.com), which is probably the most evidence-based, critical source of information on mental health treatments going.
Correction: Last month, I said Canadians will consume $36 billion worth of prescription drugs this year, but that figure includes prescription and non-prescription drugs. Prescription drugs only consume about $28 billion a year. Sorry for the confusion. Many thanks to Dr. Joel Lexchin – his fabulous book on Canada’s drug industry is coming out soon – for rapping me on the knuckles.
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Alan Cassels is a drug policy researcher at the University of Victoria; he works with unions to help improve drug benefits for their members and with doctors and researchers trying to find ways to reduce the harms related to overprescribing, especially in the elderly. www.alancassels.com
February 7: Alan Cassels speaks at the Health, Wellness and Sustainability Festival in Victoria. www.healthandwellnessfestival.ca
When I experienced anxiety/panic attacks at 30 following a stressful and somewhat traumatic period in life…my doctor was thrilled that I wanted to see a counsellor. I was given an extremely low dose Ativan for when needed. Family doctor made me promise to come back and be open to daily medication if talk therapy didn’t help. We were both happy that it did. I have had to go in for ‘tune up talk therapy’ sessions from time to time. I also still keep Ativan on hand for the occasions when anxiety lurks. I consider myself fortunate that it does…at least at this point
It is refreshing to hear a sane voice in the matter of antidepressants. I at first did not believe how many people have been using antidepressants so I started asking this simple question to anyone I met in my day. Are or have you ever been on an antidepressant ( I was gentle in my approach and never offended anyone with the question). I was shocked at how many people answered yes. We had open and honest conversations about why they chose to take the medication. They told me there friends told them it was the right thing to do and that doctors offered them no alternatives.
Prozac made me suicidal and scarred my lungs making breathing deeply almost impossible and painful. Many people with ‘depression’ have problems that go much deeper ie. early childhood and antidepressants don’t do anything to deal with early, Developmental Trauma.
Zinc and Magnesium supplementation makes me feel more stable and increases brain Serotonin levels, as does a good massage.
This is a marvelous discussion. Keep this kind of drug busting going, since there does not seem to be one single learned society left to do this critical work. Corruption has reached everywhere.