There is an interesting study out in the Journal of Clinical Psychiatry that has concluded that the majority of people taking antidepressants may not actually have depression. The study found that more than two-thirds (69 per cent) of people taking antidepressants did not meet the criteria for major depressive disorder, or clinical depression.
Some 38 per cent of those taking the drugs did not meet the criteria for obsessive compulsive disorder, panic disorder, social phobia or generalised anxiety disorder either. More than two thirds of people taking antidepressants did not meet the criteria for clinical depression.
The researchers believe that doctors are prescribing the drugs without real “evidence-based indications.” Instead, it appears that people who are experiencing normal periods of blues or unhappiness are being put on these regimes. The official guidelines state that clinical depression should be diagnosed if a person has five or more depressive symptoms over a two week period. These periods are supposed to cover most of each day and nearly every day.
The United States is not the most medicated. That position belongs to Iceland with 106 doses a day for every 1,000 inhabitants — followed by Australia, Canada, Denmark, Sweden and Portugal. The lowest levels? Chile and South Korea.
Source: Daily Mail
Please take note that some anti-depression meds have other applications. For many years I have taken 25mg daily of amitriptyline for recurring headaches. This is a mild antidepressant that has been in wide usage for decades. My script is generic and costs next to nothing. It was substituted for expensive migraine meds as an “experiment” and actually worked! I am also concerned about the over prescribing of meds, including antidepressant meds, but, please remember to dig a layer or two down before jumping to conclusions on any statistic. I have no idea how many people use antidepressant meds for purposes other than depression, but, that type of usage may modify the impact of this report.
Take your Soma and shut up!
1. It depends on if you believe that major depression criteria accurately define ‘depression’. Or OCD, panic disorder, etc.
Most doctors do not document much less perform these criteria. If they do, it’s largely from a questionnaire.
2. It also depends on if you believe that an interview performed some time after the initial diagnosis correctly ascertains the same facts as the initial diagnosis. That is, an interview on day one reveals the same results as an interview one, two or three years later about that first interview.
3. Psychiatry research veers between complaining about over-diagnosis of psychiatric disorders and associated overtreatment, and under-diagnosis and under treatment.
It is all about the eyeballs; i.e., getting into the newspaper, and addressing some social agenda.
4. “We’re not even sure that SSRIs work for typical MDD, …consider the hardly impressive 10% improvement over placebo.
The fact that I can knock 12 points off a Hamilton Depression scale with an Ambien and BID Krispy Kream should serve as a warning about the validity and generalizability of the term “antidepressant.” ”
That is, what is being treated may not be Depression, but it is something.
People came in with complaints/suffering (no one forced them), they were give a medication and a diagnostic code to permit payment.
Then what is it they actually had?
Can’t ignore the off-label usage:
“Whereas other antidepressants lower libido, this drug “may enhance” sexual arousal.” (about Wellbutrin (see below))
http://www.theguardian.com/books/2012/oct/17/bad-pharma-ben-goldacre-review
“If you were shocked by the MPs expenses scandal, try this one: in America, a popular media doctor, Drew Pinsky, goes on air to praise the antidepressant Wellbutrin. What’s so great about it? Whereas other antidepressants lower libido, this drug “may enhance” sexual arousal. What his loyal listeners don’t know is that Pinsky has been paid $275,000 by GlaxoSmithKline “for services to Wellbutrin”.”
Another piece of the equation is that many Americans are self-indulgent and narcissistic. Beyond that, there’s the “Got a problem? There must be a pill that will fix it” mentality.
The U.S., with about 5% of the world’s population, consumes somewhere between 35% and 40% of the world’s prescription drugs. We consume 80% of the world’s painkillers. And this isn’t counting illegal drugs or prescription drugs taken without a prescription. This isn’t just about access or wealth, we are a drug-abusing society here with dealers and pushers on every TV station and in every clinic.
Delve into the history of the antidepressant drugs and you will see “study shopping” where they test a drug over and over until they get the stats they want. And drugs that are no better, or barely better than the placebo, but that’s good enough to take them to market.
There IS some exciting research into real treatment for depression. One is the use of carefully guided hallucinogenic drugs (no kidding), and the other is in the extremely low-dose electrical stimulation from tDCS (transcranial Direct Current Stimulation). Plus of course, exercise, as mentioned above, and occasionally time, because sometimes life on planet Earth just sucks for a while.
“John Oliver attacked Big Pharma last night. Here’s one important thing he left out.”
http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/09/john-oliver-attacked-big-pharma-last-night-heres-one-important-thing-he-left-out/
“There’s one important thing that Oliver left out, though — the Web site doesn’t work all that great, at least not yet.
“Because of a provision in the Affordable Care Act, you can now use a government-run database to see how much drug and medical device companies pay doctors for consulting fees, travel junkets, free turkey sandwiches, clinical research and more — any payment worth at least $10. When the Open Payments database launched in September, we found out that these firms paid at least $3.5 billion in marketing to doctors between just August 2013 and December 2013. These dollars were shared by 546,000 individual physicians and 1,360 teaching hospitals.”
Rejoice, rejoice in the church of the free market. The drug companies are just exercising their First Amendment religious rights. Oops. Sorry. Must be hung over from reading prior posts.
Michael Haz,
Not a chance. Jog around the block a few times, if you’re able.
“Yes, it does happen. The drug reps come bearing gifts. ” -Ingannie
And the expensive dinners for docs, nurses… to push the drugs, encourage off-label usage.
This is depressing.
Do I qualify?
“It was a change in the law that pemitted (sic) advertizing.” -buckaroo
It’s part of the equation, but there’s more to it.
Yes, it does happen. The drug reps come bearing gifts. Oftentimes for the entire office. Undue influence, how ethical was that? I understand that this bribery has slowed down under the closer scrutiny of the government.
Oh, for heaven sake, every doctor isn’t Wm Osler or greedy. It was a change in the law that pemitted advertizing.
http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/
“For Depression, Prescribing Exercise Before Medication”
“Aerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants?”
“In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.
Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.”
http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt
Those stats really bum me out.
The title of the second article posted in my previous comment:
“Drug Companies Court Doctors with Gifts, Vacations”
As I said: Follow the money. It’s that simple.
All but begs for the standard, “Hell, in my day, we just drank whiskey and listened to ol’ Patsy and Hank, and pretty soon, why, everything was OK until the Pohlice come along on account of I kilt all a them folks.”
Follow the money:
“Dollars for Docs: How Industry Dollars Reach Your Doctors”
https://projects.propublica.org/docdollars/
http://www.8newsnow.com/story/24001284/i-team-drug-companies-court-doctors-with-gifts-vacations
“Americans are the most pill happy people on earth, largely because marketing campaigns by drug companies have successfully targeted consumers and doctors, but it comes at a steep price.
“Over 100,000 die every year from properly prescribed drugs in hospitals. That’s not the ones outside where people can misuse them. The Vioxx scandal killed thousands. The FDA hid the whole thing until a whistle blower in their organization disclosed it,” Sardi said.
Direct kickbacks to doctors are illegal, so drug companies, and medical supply firms which make things like surgical screws, have found increasingly creative ways to put money into doctors’ pockets. This quid pro quo often has little to do with patient needs.
“We have pharmaceutical representatives coming into the office, peddling drugs that are not better than the older drugs because they went off patent and you can’t make blockbuster money on it. They call them blockbuster drugs. We are now using drugs that don’t work as well. The only way they can hang onto the business is to buy off the doctors. The problem is, everybody is now in on it. Everybody,” Sardi said.
“And the money has been really sort of astonishing,” said Tracy Weber of the non-profit journalism organization Pro Publica.
She helped compile a database that is the first quantifiable glimpse into the murky world of big pharma payments to doctors. The database is admittedly incomplete because the industry doesn’t give out such information voluntarily, but the numbers for a three-year period are jaw dropping.
“We have payments stretching back to 2009 and there’s $2 billion in payments for such things. It’s accounted for 2 million payments and some of the physicians receive astonishing amounts. One doctor has received over $1 million in speaking and consulting fees. We know that physician gets it from other companies, as well, that are not in our database. We wonder how is a physician able to do his job when he is receiving so much money on behalf of the drug?” Weber said.
The only reason Pro Publica was able to get financial records from 15 major drug companies is because those firms were charged with crimes by federal authorities. Drug and medical supply companies spend hundreds of millions per year to influence medical providers. They provide gifts to doctors, free samples, lavish meals and entertainment, speaking fees for speeches written by the drug companies, first class travel to exotic destinations, or sign up doctors as “consultants.” The reason they spend so much is because it works.
“Ninety-four percent of doctors have some affiliation with a drug company or a medical device company. I know from various research studies that doctors are influenced by such things you just mentioned, gifts, speaking fees, honorariums. Drug companies are not stupid. They are not going to be doing this if they don’t think it helps the bottom line,” said Dr. Leana Wen.
“Drug company sales reps keep in their hands the exact numbers of how much drugs the doctors each prescribe, and they are always trying to move the needle to get the doctors to prescribe more of their drugs,” Tracy added.
In the last few years, companies have paid billions to settle kickback lawsuits in which they encouraged doctors to prescribe drugs for unapproved uses. Two weeks ago, Johnson and Johnson paid a whopping $2.2 billion because its sales force gave kickbacks to doctors and nursing homes to dispense drugs that proved harmful to children, seniors, and the disabled.
In October, Omnicare paid $120 million because of kickbacks paid to the nation’s largest nursing home pharmacy. Eli Lilly paid $1.4 billion in fines after its sales force “disregarded the law.” GlaxoSmithKline reached a $3 billion settlement for coaxing doctors into prescribing Paxil for unapproved uses.
The list of settlements is long, and many hit close to home. A Nevada medical device company was fined $30 million for paying doctors what amounted to bribes, including first-class travel for doctors’ mistresses. A Swiss company Novartis gave doctors trips to lavish Las Vegas resorts or fishing excursions. Aggressive marketing not only put patient’s health at risk but caused millions in false claims being submitted to public health programs.”
Could be that doctors are being overly cautious. If a patient is depressed, the doctor doesn’t want to risk possible suicide; better to prescribe an antidepressant and hope it helps.
I wonder how much of this is attributable to the plethora of TV adverts?