Are we really a “Prozac Nation”—brain-tamed on Prozac, Paxil, Zoloft, Luvox or a dozen other antidepressant agents? The National Center for Health Statistics tells us that one in 10 Americans over the age of 12 is on an antidepressant. Even more astounding, that statistic is nearly one in four among women aged 40 to 60.
With numbers that high, clinical depression—the kind that is a debilitating emotional illness and not just a passing day of the blues—must be overdiagnosed. This was confirmed by researchers at the Johns Hopkins Bloomberg School of Public Health. Their study looked at 5,639 patients in whom depression was diagnosed. It found that only 38% of the patients had symptoms that met the criteria for a depression diagnosis as established by the American Psychiatric Association. In study participants who were 65 or older, a certain other emotional illness was misdiagnosed as depression 87% of the time. That’s outrageous!
The problem, at least in part, might lie with who’s diagnosing depression and, in turn, prescribing the glut of antidepressants. In fact, the vast majority of these prescriptions are written by primary-care doctors and not by psychiatrists.
Michael Banov, MD, a behavioral medicine and psychiatry specialist and author of the book Taking Antidepressants: Your Comprehensive Guide to Starting, Staying On, and Safely Quitting, doesn’t see the situation in black and white. He believes that a number of people on antidepressants don’t need them but request prescriptions—and get them—from doctors as quick fixes for complex problems. He also believes that many people who desperately need psychiatric care don’t get appropriate help because of the stigma attached to it, ignorance about it, financial issues or other concerns. It’s easy to seek help from a primary care doctor and get a prescription for a psychiatric drug. It’s a lot more time, effort and money to receive a full mental health evaluation from a psychiatrist or behavioral health therapist.
Diagnosing depression is a specialized skill, according to Dr. Banov—not something that can be pulled off effectively a in 10-minute visit to the busy office of a general practitioner. As for psychiatric drugs, such as Prozac, Paxil and other antidepressants, they do have their place. They can be good tools to improve symptoms, in Dr. Banov’s view. Ideally, drug therapy should be temporary and coupled with other strategies that become the main focus when drug therapy is completed.
These other strategies, of course, are also alternatives to antidepressants. Cognitive behavioral therapy and psychodynamic therapy have been proven to work. Lifestyle changes, including more exercise less drinking and managing stress better, can help. And natural supplements and dietary changes are also effective.
As mentioned above, the Johns Hopkins study showed that overprescription of antidepressants was especially a problem among the elderly. Dr. Banov said that antidepressants are often used to control older people who, for example, are suffering from dementia when they should be receiving more appropriate and meaningful care. Think about it—you may have a family member in a nursing home who is given an antidepressant because he or she is irritable and easily agitated. That person may really need more exercise and creative stimulation…or may have an underlying medical issue, such a thyroid problem or a nutritional deficiency, that is being overlooked.
On the other hand, older people who actually do have depression sometimes do not get the exact treatment they need because their symptoms are diagnosed as dementia, said Dr. Banov. For this very reason, said Dr. Banov, “a patient’s care should be a partnership between the patient and doctor. And if at all possible, patients should educate themselves about depression, ask their doctors questions about treatment options and find out what the other alternatives are,” he said.
