Introduction
Antidepressants are drugs intended to combat the symptoms of the condition that gives them their name, such as negative moods and anxiety. With that said, they were initially intended as a secondary tool to help with the treatment of particularly severe cases of the condition that would resist treatment or impair day-to-day operation. However, over time, this original purpose was warped, and nowadays, antidepressants are applied in a large selection of situations.
This expansion is problematic, given the dependency concerns and adverse side effects with which many antidepressants are associated. Moreover, it can mean that physicians are treating symptoms rather than underlying mental issues, which can significantly worsen the patient’s condition. This research paper asserts that doctors are prescribing antidepressants excessively and inappropriately, leading to the masking and exacerbation of mental issues as well as numerous side effects.
Antidepressant Prevalence
In recent decades, the usage of antidepressants has been growing steadily, both in the U.S. and outside it. Per Brody and Gu, compared to 2009-2010 figures of 7.1% and 13.8%, in 2017-2018, 8.7% of men and 18.6% of women were using antidepressants. As Fig. 1 shows, the tendency of the individual to use these drugs depends on their gender, with women twice as likely to do it as men, as well as age, increases along with the age category.
The consumption of antidepressants in women also grew faster than in men, suggesting that if the problem is not addressed, it may be exacerbated further in the future. With an overall uptrend and a total figure of 13.2% of the population, the usage rate of antidepressants is concerning. The information is put into perspective if one considers the prevalence of major depression, for which the drugs are intended, in the same group.
Major depression has been on the uptrend along with antidepressant usage, whether due to better detection or worsening mental health conditions. Luo et al. find that 6.1% and 10.4% of adults were diagnosed with the condition in 1996 and 2015, respectively. Brody and Gu add that, in 2018, 7.2% of Americans had had a major depressive episode within the last year. With that said, while this figure represents substantial growth, it is still below the numbers for antidepressant usage. Other remarkable statistics that can be found in the evidence include the increased likelihood for white non-Hispanic and college-educated people to rely on drugs (Brody and Gu).
As such, culture may play a part in the prescription and usage process. Alternatively, a college education may be associated with a higher socioeconomic status and better access to healthcare, meaning mental issues are diagnosed and medications prescribed more often.
Reasons for Excessive Prescription
The first reason for people being prescribed antidepressants that need to be considered is the purpose for which they are intended, depression. The drug category is appropriate in this situation, though it should be combined with treatments that address the underlying condition. Moreover, if all cases of major depression are associated with a prescription, then, based on the statistics above, the number of cases of inappropriate prescriptions would not appear as excessive as originally depicted.
With that said Luo et al. claim that, in 2015, 30.6% of patients with major depressive disorder did not receive antidepressants while another 16.1% were prescribed with suboptimal doses. This figure is not necessarily problematic, as these patients’ physicians may have decided that the condition could be treated without risking the medication. However, it bears problematic implications for the remaining antidepressant prescriptions.
One significant category that may explain the disparity between MDD cases and antidepressant prescriptions is off-label usage. Many of the drugs have additional effects that diverge from their stated purposes, and physicians may therefore prescribe them for unrelated conditions for which they may not be approved. While the medical practitioners may have established motivations for doing so, Wong et al. conduct a study for Canada and find that only 15.9% of all such prescriptions had strong scientific evidence for their usage while 44.6% had none for either themselves or any other medications in their class. As such, the presumption may be made that physicians underestimate the dangers and use antidepressants as replacements for appropriate drugs for whatever reason. Even when an antidepressant is appropriate, another in the same category will often be better suited to the purpose.
The specific purpose behind different off-label prescriptions depends on the effects of the medication in question. Wong et al. claim that the most common reason is insomnia, for which trazodone is sometimes used due to its sedating effects. Other significant use cases include amitriptyline for pain and citalopram for anxiety and panic disorders. However, the authors have also been able to find considerable numbers of off-label prescriptions for large numbers of other drugs, with many contributing to over half of the total prescriptions.
Trazodone and amitriptyline are particularly notable because of their high usage combined with over 80% of prescriptions not being for their intended purposes (Wong et al.). Overall, it appears that, over time, physicians have developed antidepressant prescription guidelines for non-depressive conditions that do not necessarily correspond to science.
These patterns of prescription may be based on an inadequate understanding of the dangers of antidepressants, which may be informed by the guidelines regarding their usage. Luo et al. claim that the APA guidelines recommend the drugs as first-line treatments for mild depression despite studies finding that they do not generate significant advantages over placebo. As a result, doctors may misjudge the dangers of antidepressants and assume that they are suitable for a variety of conditions adjacent to mild depression, as well. The significant increase in antidepressant monotherapy described by Luo et al. may support this assumption.
Overestimating the effectiveness of the medication and underestimating the problems it generates, physicians use it for other conditions, as well. However, in doing so, they create a variety of side effects that have significant and self-perpetuating effects on the population.
Effects of Excessive Prescription
The first and potentially most significant effect of antidepressant overuse is the masking of conditions that they are intended to address. As stated above, the drugs are meant to mitigate the symptoms that depression creates. However, with no other interventions to address the mental issues themselves, the patient is left to handle their issues alone. This scenario is becoming increasingly common, as well, as the number of antidepressant monotherapy patients with MDD grew from 4.95 million to 12.95 million between 1996 and 2015 (Luo et al.). All of these patients are not necessarily likely to be able to overcome their issues or attempt to do so, given that continued medication usage is the easier option. However, if they do not recover themselves, stopping the drug regime leads them to relapse, as the underlying causes have not been addressed. This long-term usage and the inability to stop tie into dependency, another significant problem related to antidepressants.
While the return of the condition is a significant problem related to stopping antidepressant usage, many of the drugs also cause withdrawal symptoms. For example, venlafaxine may cause a variety of symptoms, both physical and mental, shortly after one misses a dose. However, Luo et al. find that almost 50% of prescriptions for such drugs are long-term and therefore likely to create a dependency. The fact that less withdrawal-prone medications exhibit similar rates of long-term prescriptions suggests that physicians may not take this quality into consideration. Overall, these tendencies have resulted in growth in long-term antidepressant usage, with prescriptions five and more years-long increasing from 13.4% of the total in 1996 to 43.9% in 2015 (Luo et al.). This growth has been associated with corresponding levels of addiction and withdrawal symptoms.
Much of the literature, such as the APA guidelines, downplay the effects of antidepressants, but direct patient studies tend to contradict these assertions. Read and Williams finds that 27.4% of patients taking antidepressants for less than three years and 36.8% of those using them for three years or more reported addiction (181). The figures may be higher if they take other medicines, as well, which is possible and not necessarily rare.
Moreover, 55.4% of all participants reported withdrawal symptoms, and 23.8% claimed their withdrawals were severe (Read and Williams). Regardless, per Read and Williams, the APA guidelines refer to the idea of antidepressant addiction as a misconception, with similar sentiments expressed by the Royal College of Psychiatrists in the United Kingdom. With that said, even without addiction concerns, antidepressants are associated with a variety of other problems.
Many patients may not be adequately informed about the adverse side effects of the drugs they are prescribed, which may contribute to their willingness to continue taking them. In the study by Read and Williams, only 34% of the participants recalled being informed about any side effects, and the information that was imparted tended only to concern biological issues (183). However, in practice, antidepressants can cause a variety of issues that the users only learn about afterward.
Read and Williams report experiences such as numbness, detachment, sexual difficulties, not feeling like oneself, drowsiness, weight gain, insomnia, dream distortions, positive feeling reductions, agitation, dry mouth, reduced ability to care, dizziness, headaches, nausea, suicidality, aggression, and tremors (181). Many of these effects occurred to a majority of the participants, typically in conjunction, raising questions about the safety of the drugs.
Conclusion
Overall, many different issues appear to be related to the usage of antidepressants in the United States. They are often prescribed inappropriately and without any other treatments, leading to long-term addiction. Moreover, patients are frequently uninformed about the adverse effects of the medications and experience them later. With that said, research into the topic, especially in the United States, appears to be lacking. Moreover, institutions such as the APA appear to be actively promoting the narrative that there are few to no issues involved in the prescriptions. More research is necessary, particularly into the effects of antidepressant usage for off-label prescriptions.
Works Cited
Brody, Debra J., and Qiuping Gu. “Antidepressant Use Among Adults: United States, 2015-2018.” CDC, 2020. Web.
Luo, Yan, et al. “National Prescription Patterns of Antidepressants in the Treatment of Adults with Major Depression in the US Between 1996 and 2015: A Population Representative Survey Based Analysis.” Frontiers in Psychiatry, vol. 11, 2020. Web.
Read, John, and James Williams. “Adverse Effects of Antidepressants Reported by a Large International Cohort: Emotional Blunting, Suicidality, and Withdrawal Effects.” Current Drug Safety, vol. 13, no. 3, 2018, pp. 176-186.
Wong, Jenna, et al. “Off-Label Indications for Antidepressants in Primary Care: Descriptive Study of Prescriptions from an Indication Based Electronic Prescribing System.” BMJ, vol. 356, 2017. Web.