By Bruce E. Levine, AlterNet
Posted on October 26, 2011
The U.S. Centers for Disease Control and Prevention (CDC)
recently reported that antidepressant use in the United States has
increased nearly 400 percent in the last two decades, making
antidepressants the most frequently used class of medications by
Americans ages 18-44. Among Americans 12 years and older, 11 percent
were taking antidepressants by 2005-2008 (the most recently reported
study period), and 23 percent of women ages 40–59 years were taking
them.
Why has U.S. antidepressant use skyrocketed? Are the symptoms of what is commonly called depression—helplessness, hopelessness, and immobilization—always
evidence of a medical condition? Or is it time to repoliticize a great
deal of our despair, and reconsider the old-fashioned antidepressant of political activism?
Common Explanations for Soaring Antidepressant Use
Nowhere in the CDC report is there any explanation for the 400
percent increase of antidepressant use from 1988 to 2008, however, there
are several common explanations offered by mental health professionals
and journalists.
Money is a large factor. It has become more lucrative for
psychiatrists and other physicians to prescribe medication than to
provide talk therapy. This was detailed in the New York Times March 2011 investigative report “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”
which reported, “A 2005 government survey found that just 11 percent of
psychiatrists provided talk therapy to all patients.” Actually, most
antidepressant prescriptions are written by physicians other than
psychiatrists and, according to the recent CDC report, among Americans
taking one antidepressant, less than one-third of them have seen a
mental health professional in the past year.
Antidepressant use has also skyrocketed because of the increased
practice of prescribing antidepressants for many conditions other than
severe depression, and prescribing them for longer periods of time.
Among the 2005-2008 antidepressant user group (no data offered on
earlier study periods), only 33.9 percent had severe symptoms of
depression; 28.4 percent of antidepressant users had moderate symptoms;
and 19.2 percent had mild symptoms; while 7.6 percent had no depression
symptoms. And, according to the CDC report, more than 60 percent of
Americans who are taking antidepressants have taken them for 2 years or
longer, with 14 percent having taken them for 10 years or more.
According to antidepressant manufacturers, the increase in
antidepressant use has been caused by their creation of more effective
antidepressants, including the so-called selective serotonin
reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft which
came on the market in the late 1980s and early 1990s. However, by the
late 1990s, psychiatry textbooks had already rejected the idea of
increased effectiveness of SSRIs (for example, Robert Julien’s A Primer of Drug Action (1998) states, “The newer antidepressants [SSRIs] are not necessarily more effective than the older TCAs [tricyclics] ).”
Rather than SSRIs’ greater effectiveness, it was their greater
publicity that stimulated public acceptance. One publicity coup
commenced in 1997 when U.S. government agencies changed the rules for
broadcast advertising, no longer requiring full information about
side effects (which had previously made it problematic for drug
companies to run a thirty-second spot). TV advertising dramatically
increased patient requests for antidepressants from their physicians. A
study reported in 2005 by the Journal of the American Medical Association, “Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants,” concluded, “Patients’ requests have a profound effect on physician prescribing.”
A Neglected Explanation: The Depoliticizing of Despair
A largely neglected explanation for the huge growth of antidepressant
use is that Americans have increasingly been socialized to equate all
states of demoralization and immobilizing despair with a medical
condition, and to seek medical treatment rather than political
remedies.
Depression is highly associated with a variety of overwhelming pains,
including physical pain, relationship pain (such as a dissatisfying
marriage and social isolation), trauma—and financial pains.
Financial pains include unemployment, poverty, and debt. In 2007 the U.S. Substance Abuse & Mental Health Services Administration reported
depression in 12.7 percent of unemployed people compared to 7 percent
of employed people. And the Urban Institute in 1996 reported that
Americans on public assistance have at least three times higher rate of
depression than those not on public assistance. A person who has
suffered mental illness is three times more likely to be in debt than
someone who is not in debt, according to Richard Wakerall, director of the U.K. mental health organization Mind in Plymouth.
Recently, I had a chance encounter at Cincinnati’s Findlay Market
with five young adults who reported large student-loan debt and who
appeared mildly depressed about it. I happened to be in a charged-up
mood, having just participated in an Occupy Cincy march,
and I told them that the entire U.S. $1 trillion student-loan debt
could be forgiven if the U.S. government paid it off rather than funding
the damn military-industrial complex, which costs us over $1 trillion a
year if you include everything. They started to smile and look more
energized, and three of them seemed interested in the Occupy Cincy
movement. If America’s millions of depressed student-loan debtors could
politicize their despair and take it to the mall in Washington D.C., we
could dwarf the crowds in Tahrir Square.
Can Activism Be an Antidepressant?
Almost as soon as I entered Freedom Plaza in Washington D.C. on
October 6, I experienced a wave of pleasant feelings and energy. My
wife, Bon, and I showed up about 10am on the first day of “October 2011”
(“Occupy Freedom Plaza”) in Washington D.C. after driving there from
Cincinnati. In sharp contrast to the blank and depressed faces that I
had just seen on the D.C. Metro and on the D.C. streets, we were now
surrounded by a thousand or so people who were smiling, laughing,
engaged in political discussions, and eagerly awaiting the day’s events.
I chatted with two of the organizers, David Swanson and Margaret
Flowers, and found their hope and energy a supreme antidote to cynicism.
The opposite of depression is vitality, and so by just stepping into
Freedom Plaza, I had received a strong antidepressant.
Then came the day’s major march. Depression is much about feeling
hopeless, alienated, isolated, and powerless, and this march was an
antidote to all those feelings. For a couple of hours, we felt some real
power. We marched on the streets— not the sidewalks—and traffic was
blocked by police, who for those moments in time actually were the
People’s servants. We marched past the White House and the Treasury,
paused at the U.S. Chamber of Commerce to “drop off some job resumes”
and for some short speeches, then up and over to K Street, with many
cars honking approval and some non-marchers on the sidewalks raising
their fists and shouting encouragement. Then back to the Plaza, and a
couple of hours later a General Assembly.
The General Assembly was attended by about 500 people who
experienced, some for the first time, a non-hierarchical,
anti-authoritarian, respectful democracy where the issues of the day
were discussed. No one was rude and all seemed jovially patient. We
hadn’t planned to stay more than that day, but leaving the Plaza late
that evening, we had an urge to return.
The next morning, I found my pace quicken as I headed from the Metro
station back to Freedom Plaza, as I was excited to return to this piece
of “federal property” that had begun to feel like a “People’s Oasis.” We
had succeeded, at least for the time being, in taking back a small
piece of the United States and restoring it to some kind of sanity and
humanity. A section of the Plaza was filled with sleeping bags,
backpacks and cardboard shelters, and our food, media, and first-aid
tents still stood.
We decided to prolong our visit and stay for the afternoon march to
the Martin Luther King Memorial. At this march, there were the chants
that are common to all Occupy marches: “We are the 99 percent.” “The
banks got bailed out, we got sold out.” “Hey, hey, ho, ho, corporate
greed has got to go.” “Show me what democracy looks like. This is what
democracy looks like.” On this march, we paused at the International
Trade Center (in the Ronald Reagan Building), where there were about 75
demonstrators protesting the tar sands pipeline. As some of our marchers
had earlier participated in their protest, the pipeline protesters
returned the favor by joining our march. We shouted our appreciation and
our morale kicked up another notch.
Leaving Freedom Plaza at the end of my short stint there, I thought
that even a little dose of democracy, especially when it has not been
experienced, is the best damn antidepressant that many people will ever
experience. And even if the cynics are right and the movement dies from
cold weather or gets large enough for the corporatocracy to bring out
their tanks and crush it, something still will have been won. Everybody
who participated will remember that their demoralization and despair was
“cured,” at least for a time, not by a pill or any other consumer
product but by their own political actions.
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