Just last August, a study was published in JAMA in which adolescents were screened for depression and then randomized either to a collaborative care intervention or usual care. An accompanying editorial called for integration of depression screening into primary pediatric care, noting that "depression is associated with serious mental health problems (e.g., suicide)."
In fairness, it should be pointed out that in the above-mentioned study, the families of the children labeled depressed were offered a choice of medication or psychotherapy (54% chose medication in combination with psychotherapy, and 4% chose medication only). But if and when this sort of program is rolled out to the wider public, will families even be offered that choice? Or will they merely be told their child "needs" powerful drugs to correct a "chemical imbalance" in her brain?
Centuries from now, will historians read about our era and shake their heads and wonder: What kind of people were these "Americans?" What kind of people would use suicide prevention as a justification for giving people "medications" with a known link to suicidal behavior going back more than fifty years?
Today, antidepressants are a twenty-billion-dollar-a-year industry. One out of nine Americans aged 12 or older currently is taking these drugs, including a staggering 23 percent of women between the ages of 40 and 59. Of the twelve members of the Mood Disorders Work Group for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, one or more admit to taking money from each of the following companies: Eli Lilly (Prozac), Forest Laboratories (Celexa), Pfizer (Zoloft, Effexor), Abbott Laboratories (Luvox), and GlaxoSmithKline (Paxil, Wellbutrin). In just the last six years each of these companies has paid hundreds of millions of dollars to settle claims of illegal marketing, including a whopping $3 billion paid out by GlaxoSmithKline in 2012 in what was the largest health care fraud settlement in United States history. The US Department of Justice accused GSK of a variety of illegal marketing practices, including preparing a misleading medical journal article that claimed that a clinical trial demonstrated that Paxil was effective for treating depression in children when the study did not in fact do so, and paying for lunches, dinners, and spa treatments for doctors who attended talks given by speakers paid by GSK to promote the use of Paxil in children.
Before we go any further down this road, shouldn't we think long and hard about where we are going? There has never been a time in history in which more people enjoyed a higher standard of living than right now, and yet here in the United States we consume such prodigious quantities of antidepressants that our rivers now contain not just measurable amounts of Prozac but enough to alter the behavior of fish living in the water. Why wasn't this front-page headline news?
As for Brenda, she was hospitalized after her suicide attempt but eventually managed to win her release. With her doctor's assistance, she has kicked the psych meds. By now she has been drug-free for six months, but she still hasn't gotten back to the way she was.
"I still have no emotions except horrible ones. I can't laugh. I can't feel happy. I can't enjoy anything." The anxiety continues, along with the feelings of agitation. "I can even feel it in my dreams." She also experiences "brain zaps," or feelings of electric shocks inside her head, as well as disturbances in her field of vision. "My life is a living nightmare. It's almost like being on a horrible drug trip you can't get out of.
"It's not just getting through every day--it's literally [about] getting through every minute. It's just a nightmare. You get times when you feel a little bit better, and then you get slammed backwards.
"I think of how independent I was, and creative, how capable I was. I was someone who used to do stuff for people all the time, and now I'm not able to do anything at all.
"I can't see people, and when I do see people, I don't feel anything. I can't feel what I'm meant to feel. It's just gone. I've lost my feelings of love and connection.
"You know, these Christmas fairs, I loved to go to that sort of thing. If I go to them now, it's almost like being in a nightmare. You just can't enjoy it. I just feel terrified.
"My life is walking nightmare."
List of Sources
Richardson, L.P. et al. 2014. Collaborative care for adolescents with depression in primary care: A randomized clinical trial. JAMA 312:809-816.
Reeves, G.M. and M.A. Riddle 2014. A practical and effective primary care intervention for treating adolescent depression. JAMA: 312-797-798.
Beissner, A.R. and J.E. Blanchette 1961. A study of suicides in a mental hospital. Diseases of the Nervous System 22:365-371.
Krieger, G. 1966. Suicides, drugs, and the open hospital. Hospital and Community Psychiatry July 1966 pp. 196-199.
Avery, D. and Winokur 1978. Suicide, attempted suicide, and relapse rates after depression. Archives of General Psychiatry 35:749-753.
Fuerenstein, T.J. and R. Jackisch 1986. Why do some antidepressants promote suicide? Psychopharmacology 90:422.
Hyman, S.E. 2012. Revolution stalled. Science Translational Medicine 4:1-5.