Antidepressants - Usage Trends

Usage Trends

"I think the categorical belief is that depression is something you get over rather than something you take medication for," stated Dr. Zachary N. Stowe in an interview with Laurie Tarkan for the New York Times. Indeed, some "four out of five people with depression will get completely better without any help," noted the authors of "Depression: Help Is at Hand." Episodes of depression frequently last for eight months to a year before going away. For some depressed people, however, the symptoms hang on even longer.

September 11, 2001

Doctors reported that requests for antidepressants increased dramatically after the terrorist attacks of September 11, 2001, on American soil. Fear, depression, and anxiety were common among Americans after terrorists hijacked planes and flew them into the World Trade Center in New York City and the Pentagon in Washington, D.C.

Of the one in five people with depression that does not go away on its own, treatment is recommended. Without help, those people are twice as likely to fall into a pattern of repeated depressive episodes. A 2003 Time magazine article pointed to the potential seriousness of the condition. "Untreated depression has a lifetime suicide rate of 15 percent—with still more deaths caused by related behaviors like self-medicating with alcohol and drugs."

The Debate over SSRI Safety and Suicide Risks in Children and Teens

As more and more children and teens are diagnosed with depression, the effects of the drugs used to treat it must be evaluated in young people. Some experts worry that anti-depressants may act differently in people under the age of eighteen because their brains are not yet fully mature. "Our knowledge of antidepressant treatments in youth, though growing substantially, remains limited when compared with what we know about treatment of depression in adults," stated the authors of the NIMH article "Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers."

According to Christian Science Monitor correspondent Patrik Jonsson, two separate congressional hearings revealed that the U.S. Food and Drug Administration (FDA) had "known about problems with [antidepressant] drugs since 1996, but failed to take decisive action." These "problems" included higher rates of aggression and an increase in suicidal thinking among young patients being treated with antidepressants. By 2000, even more studies had emerged "showing a possible link between hallucinations and aggression in children and teens taking Zoloft, Paxil, and Prozac," reported "FindLaw" columnist Elaine Cassel on CNN.com. Despite these findings, in January of 2003 the FDA approved the use of Prozac in depressed children as young as seven years old. As of 2005, only ProzachasbeenapprovedtotreatdepressionandOCDinchildren. Zoloft, Luvox, and Anafranil are only approved for children for OCD. As of 2005, no other antidepressant is approved for use in children.

Defining Depression

Depression is hard to define, and not all doctors agree on whether it is a mood disorder or the more serious definition: a disease. In his 2005 book, Against Depression, Peter Kramer notes that his work presents "an insistent argument that depression is a disease." In fact, he calls depression one of the worst diseases to afflict humankind.

Dr. Peter R. Breggin sees the situation differently. In his 2001 work, The Antidepressant Fact Book, he states that "it is a mistake to view depressed feelings or even severely depressed feelings as a 'disease."' He continues: "Depression… is an emotional response to life. It is a feeling of unhappiness—a particular kind of unhappiness that involves helpless self-blame and guilt, a sense of not deserving happiness, and a loss of interest in life…. A human emotion or psychologi cal state—basically, a feeling—should not be considered a 'disease' simply because it becomes extreme."

Treatment for Adolescents with Depression Study (TADS):

To gain more information on the effects of antidepressants in young people, the NIMH spent $17 million on the Treatment for Adolescents with Depression Study (TADS), which was conducted between 2000 and 2003. More than 400 depressed adolescents were divided into groups that received varying forms of treatment. One group was treated with Prozac alone. Another group received a combination of Prozac and cognitive behavioral therapyA type of therapy that helps people recognize and change negative patterns of thinking and behavior. (BT), a type of psychotherapy that stresses positive thinking. A third group received CBT without the Prozac. A fourth group received only a placeboPronounced pluh-SEE-boh; a 'sugar pill' or 'dummy pill' that contains no medicine..

Some antidepressants have been linked to increased suicides in users. Here, the mother (left) of a deceased teen waits to testify at a public hearing before the FDA. Her son, Jacob, committed suicide at age 14 while taking antidepressant drugs.
Some antidepressants have been linked to increased suicides in users. Here, the mother (left) of a deceased teen waits to testify at a public hearing before the FDA. Her son, Jacob, committed suicide at age 14 while taking antidepressant drugs. AP/Wide World Photos.

The results of the study were released to the press by the NIMH in August of 2004. The participants were monitored for improvement in their depression and for trends in their suicidal thinking. The combination of medication and therapy proved the most effective in relieving the symptoms of depression. The data concerning suicidal thinking were more difficult to interpret.

The results of TADS revealed that 7 percent of adolescents receiving Prozac either attempted suicide or threatened to do so. Only 4 percent of participants in the placebo group had a suicide-related event. Still, the NIMH concluded that "it is extremely difficult to determine whether SSRI medications do or do not increase the risk of… suicide, especially since depression itself increases the risk for suicide." Experts believe that a larger study is needed to resolve unanswered questions.

Results Lead to "Black Box" Warnings

In 2004, the FDA examined information from more than twenty studies, including TADS, on antidepressants and adolescents. Together, the studies involved about 4,300 patients under the age of eighteen. Overall, the results mirrored the TADS findings. The rate of suicidal thinking or behavior was twice as high among adolescents taking SSRIs as it was in adolescents who were not. This prompted the FDA to announce in late 2004 that "black box" labeling of antidepressants would become mandatory. In "Antidepressant Medications for Children and Adolescents," the authors noted: "A black-box warning is the most serious type of warning in prescription drug labeling." Black box warnings for antidepressants state that the drugs may be linked with an increased risk of suicidal thinking or behavior. On its Web site, the FDA specifies the language to be used on the black box warnings. Part of the standard warning follows:

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

According to MSNBC.com, antidepressant use among children and teens has declined by about 10 percent since the information on suicide risks was released.

Testing New Drugs

The word placebo is Latin for "I shall please." Placebos, often called "sugar pills" or "dummy pills," are used in experiments that test the effectiveness of new drugs. Doctors give one group of patients regular doses of a placebo and one group of patients regular doses of the real drug that is being tested for a particular condition. Patients are not told what they have been taking until the testing period is over. After a few months, both groups are compared. A higher rate of improvement among patients in the test-drug group is good news for drug researchers. It indicates that the new drug is truly effective in treating the condition it was designed to treat.

Patients' conditions may improve for a time if they believe they are taking a medication that will relieve their symptoms. In the treatment of depression, an average of 35 percent of placebo-treated individuals will improve, compared with about 60 percent of SSRI-treated individuals.