An article published in the Science section of the New York Times today, A Glut of Antidepressants, focuses on the high rates of antidepressants being prescribed in America. According to the article, one in ten people are on antidepressants, and for women in their 40 s and 50 s, that number is one in four. The article suggests that Americans are suffering from a wide variety of side effects from the drug, and over-medication due to doctors lax prescription standards and aggressive direct-to-consumer marketing by the pharmaceutical industry.
But what counts as over medication? According to a study published in April in the journal, Psychotherapy and Psychosomatics, overdiagnosis is based on whether or not patients who were diagnosed with depression meet the criteria written in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.) for major depressive episodes (MDE).
The study included 5,639 adults who were diagnosed with depression drawn from a sample of 75,000 adults who took part in the National Survey of Drug Use and Health in 2009 and 2010. Of these adults diagnosed with depression, 38.4 percent met the D.S.M. criteria for diagnosis.
According to the D.S.M., in order for patients to be diagnosed with MDE, they have to have been in a depressed mood or felt no interest in activities for at least two weeks and also have at least five symptoms that impair functioning almost everyday.
However, because the study was based on responses of adults who were diagnosed with depression, they may have already received successful treatment, and thus would be less likely to meet the D.S.M. criteria for major depressive episodes. Similarly, those who have received successful treatment may respond to questions about their past struggles with depression differently because of their improved mood at the time of the survey.
However, it is still questionable as to whether the medication is posing a threat even if the patient does not meet the DSM criteria. According to the study, Those who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning.
Antidepressants can have a variety of possible side effects including nausea, unintentional weight changes, insomnia, dizziness, decreased sex drive and fatigue. However, most people stay on the drugs for at least two years. Some take them for a decade or more, according to the study s lead author Dr. Ramin Mojtabai, an associate professor at the Johns Hopkins Bloomberg School of Public Health.
ACSH's Dr. Gilbert Ross had this perspective: "I believe the study's authors and the Times writer both have an axe to grind. Terming as "overmedication" people who benefit from anti-depressants yet do not suffer from severe depression is unrealistic. One does not have to be immobilized by depression to have significant daily impairment. Since people seem to be staying on the medication despite side effects, and are reporting positive results, it appears that the medication is working even for those who do not meet the DSM MDE criteria."