gmusic@nurturingnatures.co.uk

9 minutes reading time (1805 words)

Antidepressants, Big Pharma, and ordinary unhappiness

Recently after an OECD report many articles have been outlining the extent to which anti-depressant use has soared in Western countries. Apparently one in ten Americans use them now, and in China there has been a 20% year on year increase in the last three years. Indeed the OECD study suggests a large rise in a wide range of Western countries, including the UK, Australia and almost as bad as anyone, Canada, although Iceland tops them all.

 

The particularly worrying thing of course is that rates of anti-depressant use have gone up while depression itself has not increased. One aspect of this might be the apparent increase in prescribing linked to the recession and financial problems, particularly apparently in Greece and Portugal. Poor economic circumstances has an effect of mental health issues, as many recent findings have shown, and for example there has been a large increase in suicide very much linked with the economic downturn in several countries (eg click to see article). However whether medication should be a serious response to these huge economic and social issues is another matter.

A raft of issues are raised by the new data on antidepressants. On the one hand it seems clear that such drugs are being prescribed for what is in fact ordinary unhappiness nowadays, rather than for the serious depressive illnesses they were designed for. Many commentators have suggested that this is symptomatic of a change in people’s expectations about the lives they should be able to live, an increased belief that we have a right to feel good and that any bad feelings should be got rid of. The unhappiness that one might see as a result of unemployment, divorce, work stress and other losses is now seen as something to be medicated. Freud’s dictum about emotional health being about living with ordinary unhappiness seems very wise when compared to a consumerist culture in which people feel entitled to get rid of any difficulties immediately. There are even more perverse social symptoms beginning to appear such as drive-through funerals, presumably for people too busy to mourn.

This might link with other social trends, such as levels of empathy dropping over several decades, as evidenced by large studies in America  [1], and higher than ever rates of narcissistic character traits [2]. This probably links with other mental health issues. For example we know that in the US and UK diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) have been increasing dramatically. Short attention spans and an inability to defer gratification tend to go hand-in-hand with poorer relationships, less empathy and less prosocial behaviours. These character traits seem to have increased in a contemporary world where instant gratification is on the increase, whether in the form of fast-food, sophisticated sales techniques, easy credit, immediate downloads or instantaneous communications. For example apparently  almost 6% of Americans suffer from ‘compulsive buying’ [3], a disorder commonly occurring alongside a host of other symptoms, such as mood and anxiety disorders, and issues connected with impulse control.

Another issue is an increasingly individualised view of problems. The rise in use of medication means that instead of taking seriously the social and economic issues that might have been central to the development of these symptoms, we see a  laying of blame on individuals and more talk of people’s personal responsibility, rather than that of society. We also see developing new categories of consumers (of medication, therapies, indeed also of therapy trainings). This kind of critique has been taken forward particularly effectively by Mark Fisher in his book,  Capitalist Realism [4] who has argued that in part antidepressants and other forms of treatment can be attempts to quell anger and upset that really should be there and be expressed.

However my main worry about the rise of the use of these medications is that there is no evidence that depression, nor for that matter, other mental health issues, are improving through their use. Indeed there is a lot of evidence of things getting worse. Maybe the best account of this is Robert Whittaker’s book, The Anatomy of an Epidemic [5]. Some of his key points include the fact that people who take medication, include antidepressants, are increasingly likely to join the growing ranks of the disabled, becoming dependent on drugs which in effect change people’s brains, making it almost impossible to come off them over time and in effect creating dependency and lifetime consumers of these drugs. Indeed compared to those taking such medications in the longterm, those with similar symptoms (eg of depression) had a far better longer term trajectory of they took drugs very briefly, or did not take then at all.

Some of the studies include that spontaneous recovery without relapse was much more likely in people who did not take the medication [6], those who take medication are depressed longer than those who do not [7], that those who take antidepressants end up taking more time off work than those who do not take the medication for depression [8], that most people recover spontaneously if not treated for depression [9], and that a year after depression those who did not take the medication were enjoying far better health [10]. Whittaker has amassed a mass of such evidence. the overall picture is that medication is not helping society's mental health problems, even if individuals genuinely feel helped by such drugs, at least in the short-term. Of course the group that medication does benefit is Big Pharma.

As Goldacre points out [11], so much of the hype about medication needs to be treated with scepticism, particularly due to the trials that drug companies never publicize, let alone the worrying side-effects little heard about, and the overall lack of transparency, not to mention the massive publicity machines and financial muscle of what Goldacre calls Bad Pharma.

We might also beware of a new tranche of antidepressants that might soon be hitting our streets. These will affect the body’s hormonal mix, working on the serotonin, dopamine and noradrenaline systems, will work quicker than the SSRI’s, and are uncannily similar to cocaine in structure apparently. Given the worrying legacy of the last generation of antidepressants, we should at least be very cautious and skeptical about these new miracle drugs. Like many, I hope that we can re-focus on the social, economic and cultural issues that might be leading to this epidemic of unhappiness, an argument that many such as Gerhardt [12], James [13] and others have put eloquently. We are creating a society in which the solution to unhappiness and insecurity is a consumerist one in which we try to compensate for bad feelings by acquisitive means. Tim Kasser [14] is one of many researchers who has long since been showing in his research the links between emotional insecurity and the pull to consume.

Of course the things that we try to use to make us feel better (consumer goods, psychotropic medication etc) often do not. Some researchers  [15] recently divided a largish sample in terms of whether their happiness was of a more hedonic kind, such as from buying consumer goods or having an exciting time, or of a more eudemonic kind, that is happiness derived from engaging in meaningful activity based on personal values such as a passionate interest or a cause. The two kinds of happiness had surprisingly very different effects, right down to a genetic and cellular level.

Those whose sense of happiness and well-being derived from being motivated by a strong sense of meaning and purpose had lower levels of inflammation and higher levels of immune response and antibodies than those whose version of happiness was more hedonic. In other words the good life, as the Greeks might have defined it, gives rise to emotional and physical health, a win-win situation. On the other hand if we are motivated by a more hedonic buzz of immediate desire or a wish to achieve or consume, then physiologically this is not so good for us. It leads to more inflammation of our cells, and worse health. This is presumably the kind of happiness that is promoted in contemporary consumerist societies, the buzz of acquiring something new, the thrill of success, and this version is clearly it is not working, and  nor is the medication.

[1]        S. H. Konrath, E. H. O’Brien, and C. Hsing, ‘Changes in dispositional empathy in American college students over time: A meta-analysis’, Personality and Social Psychology Review, vol. 15, no. 2, pp. 180–198, 2011.

[2]        J. M. Twenge and W. K. Campbell, The narcissism epidemic: Living in the age of entitlement. New York: Atria, 2009.

[3]        M. D. Koran, P. D. Faber, M. A. Aboujaoude, P. D. Large, and P. D. Serpe, ‘Estimated Prevalence of Compulsive Buying  Behavior in the United States’, Am J Psychiatry, vol. 163, no. 10, pp. 1806–1812, Oct. 2006.

[4]        M. Fisher, Capitalist realism: is there no alternative? Winchester, UK; Washington [D.C.]: Zero Books, 2009.

[5]        R. Whitaker, Anatomy of an epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Broadway Paperbacks, 2010.

[6]        V. Weel‐Baumgarten, W. J. Van den Bosch, Y. A. Hekster, H. J. Van den Hoogen, and F. G. Zitman, ‘Treatment of depression related to recurrence: 10‐year follow‐up in general practice’, Journal of clinical pharmacy and therapeutics, vol. 25, no. 1, pp. 61–66, 2000.

[7]        S. B. Patten, ‘The impact of antidepressant treatment on population health’, Population Health Metrics, vol. 2, no. 2, p. 9.

[8]        C. S. Dewa, J. S. Hoch, E. Lin, M. Paterson, and P. Goering, ‘Pattern of antidepressant use and duration of depression-related absence from work’, The British Journal of Psychiatry, vol. 183, no. 6, pp. 507–513, 2003.

[9]        M. A. Posternak, D. A. Solomon, A. C. Leon, T. I. Mueller, M. T. Shea, J. Endicott, and M. B. Keller, ‘The naturalistic course of unipolar major depression in the absence of somatic therapy’, The Journal of nervous and mental disease, vol. 194, no. 5, pp. 324–329, 2006.

[10]      D. Goldberg, M. Privett, B. Ustun, G. Simon, and M. Linden, ‘The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities.’, The British Journal of General Practice, vol. 48, no. 437, p. 1840, 1998.

[11]      B. Goldacre, ‘Bad Pharma’, Fourth Estate, 2012.

[12]      S. Gerhardt, The Selfish Society: How We All Forgot to Love One Another and Made Money Instead. London: Simon & Schuster, 2010.

[13]      O. James, The Selfish Capitalist: Origins of Affluenza. Vermilion, 2008.

[14]      T. Kasser, The high price of materialism. The MIT Press, 2003.

[15]      B. L. Fredrickson, K. M. Grewen, K. A. Coffey, S. B. Algoe, A. M. Firestine, J. M. G. Arevalo, J. Ma, and S. W. Cole, ‘A functional genomic perspective on human well-being’, PNAS, vol. 110, no. 33, pp. 13684–13689, Jul. 2013.

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Comments 1

Guest - Robert Glanz on Sunday, 08 December 2013 08:11

Good Article Dr. Music. I wonder why there is a disparity though between the research, which is very compelling and peoples personal or anecdotal experiences of taking anti depressants? I really enjoyed reading Andrew Solomon's The Noonday Demon ten years ago or so and remembering how he used Anti Depressants in what seemed to be a very creative and collaborative way, helped by a psychiatrist who was very involved in how they were or weren't helping him over time. Perhaps one of the problems with these drugs is the way in which they are prescribed as a substitute for having a relationship by so many practitioners, doctors and psychiatrists. They perfectly suit the way in which our Western society has demoted the idea of relationships as cure to an afterthought or an expensive luxury, or too time consuming in an age of instant gratification when making an effort or risking intimacy is beyond most of us in our busy lives stressful lives.

Good Article Dr. Music. I wonder why there is a disparity though between the research, which is very compelling and peoples personal or anecdotal experiences of taking anti depressants? I really enjoyed reading Andrew Solomon's The Noonday Demon ten years ago or so and remembering how he used Anti Depressants in what seemed to be a very creative and collaborative way, helped by a psychiatrist who was very involved in how they were or weren't helping him over time. Perhaps one of the problems with these drugs is the way in which they are prescribed as a substitute for having a relationship by so many practitioners, doctors and psychiatrists. They perfectly suit the way in which our Western society has demoted the idea of relationships as cure to an afterthought or an expensive luxury, or too time consuming in an age of instant gratification when making an effort or risking intimacy is beyond most of us in our busy lives stressful lives.
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