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Prozac Nation


 

The United States National Health and Nutrition Examination Surveys (2005-2008) was released at the end of 2011, and reported some worrying statistics (http://www.cdc.gov/nchs/data/databriefs/db76.htm ): Eleven percent of Americans aged 12 years and over, take antidepressant medication. More than 60% of Americans taking antidepressants have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more. Comparing the rate of antidepressant use in the United States in 1988 and twenty years later, in 2008, the rate for all ages has increased nearly 400%.

The prevalence of antidepressant use in teenagers was compared between three western European countries (Denmark, Germany, and the Netherlands) and the USA. Antidepressant medication utilization in the USA exceeded that of all three Western European countries by at least 3-fold. (http://onlinelibrary.wiley.com/doi/10.1002/pds.1254/abstract ) Compared with Canada, American teenagers use antidepressants twice as frequently. (http://www.ncbi.nlm.nih.gov/pubmed/17215416 ) The prevalence of depression in Singapore is 5.6% which comparable to European countries (http://www.channelnewsasia.com/stories/singaporelocalnews/view/1004919/1/.html )

Several issues come to mind. The diagnosis of depression can be difficult, especially in children, who are less articulate and may not even inform their friends or relatives. A glance at some of the symptoms of depression in children will show how nonspecific they are (http://www.webmd.com/depression/guide/depression-children ):

- Irritability or anger.
- Continuous feelings of sadness and hopelessness.
- Social withdrawal.
- Increased sensitivity to rejection.
- Changes in appetite -- either increased or decreased.
- Changes in sleep -- sleeplessness or excessive sleep.
- Vocal outbursts or crying.
- Difficulty concentrating.
- Fatigue and low energy.
- Physical complaints (such as stomach aches, headaches) that don't respond to treatment.
- Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests.
- Feelings of worthlessness or guilt.
- Impaired thinking or concentration.
- Thoughts of death or suicide.

Compounding the problem is the rapid mood swings characteristic of children. They may even joke and declare, without really meaning it: “I want to kill myself!”

The major worry is that if one fails to recognize thoughts of suicide, the depressed individual might attempt it. In Asia, performing badly in school exams, or the fear of failing, is a major factor in precipitating suicide. One of the highest, if not the highest, suicide rates in the world, is found in South Korea, with an annual rate of 31 per 100,000. Japan is lower with a rate of 24 per 100,000, and is ranked 7th in the world. Hong Kong is ranked 26th in the world with a suicide rate of 15 per 100,000, and Singapore is ranked 44, with a rate of 10 per 100,000. (Wikipedia: http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate )

Doctors, when confronted with a depressed patient, has to assess his or her suicidal risk. This is extremely difficult. The easy way out is either to refer the patient to a hospital accident and emergency department, to a psychiatrist, or to give antidepressant medication.

The increase in the use of antidepressants among teenagers is very disquieting, because it suggests that instead of using the "talking cure" http://en.wikipedia.org/wiki/Talking_cure psychiatrists and general practitioners are resorting to medication much earlier. The abandonment of the old classification of depression into "reactive" depression (in which depression is triggered off by some unfortunate external event like the death of a loved one), and "endogenous" depression (in which the depression arises internally due to a chemical imbalance inside the brain), is one of the reasons for overprescription of antidepressants.

The theory of the talking treatment relies on the doctor getting to the bottom of the problem, discovering the factors causing the depression, and then enlightening the patient of the causation. By gaining insight into the problem, the patient can be guided to build psychological defences to overcome the depression.

The reason why antidepressants are overprescribed is that it takes far less time to write a prescription than to talk the patient out of depression.

There are many other strategies for treating depression. Emotional support by family and friends can play an important role. Persuading the depressed patient to help others by volunteering in community service, can take his or her mind away from excessive introspection. Participating in other activities like art, music, drama, sports, gardening, caring for pets, playing community games, travel, etc, can help alleviate depression.

Such nonmedical treatment is far more difficult and time-consuming, and therefore rarely prescribed by psychiatrists and other doctors. But these remedies may have better long-term outcomes.

My thesis is that some psychiatric illnesses may require unconventional nonmedical remedies. I would prefer to write a prescription recommending community service, the creative arts, sports, and travel, instead of Prozac.

Kenneth Lyen