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The Great Antidepressant Hypocrisy

Most people think Americans are popping Prozac like candy. But in reality, depression is far more common than we think. Could it be that we're not medicated enough?

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By Maia Szalavitz

11/09/11

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When the Center for Disease Control and Prevention recently announced that one in ten Americans now takes an antidepressant—a 400% increase since 1988—there was a predictable media hand-wringing about "pill popping” and a rush to “quick fixes.”  



What I always wonder when I hear these complaints is this: Have these people ever experienced depression themselves, or known someone who suffers from it? In over 20 years reporting on mental health, I’ve never actually come across a person whose first response to the slightest sadness was to seek medical help. (If you are or know of such a person, please do contact me—I’d love an interview).



In fact—and the research backs this up—most people with depression typically go untreated for years, or even decades, before finally getting treated. They often (as I personally did) tend to get lost in long, dangerous experiments in self-medication with legal or illegal drugs. Truth is, most people are reluctant to try antidepressants, rather than eagerly “ask their doctors” for the latest pill.



So why do we persist in believing that depression is over-medicated and everyone is popping Prozac like candy? The first reason is the cultural notion that mental illness should be rare.



If a cancer therapy was devised today that did away with the agony of chemotherapy and radiation, we’d be dancing in the streets. So why do we treat the idea of “popping a pill” for depression, rather than crying in a therapist’s office, with such disdain?





Although we readily accept that pretty much everyone will suffer from physical illness from time to time, few seem willing to believe that mental disorders could be equally commonplace. Indeed, reports about the high prevalence of mental illness are typically met with accusations by Big Pharma of “disease mongering” (which, to complicate things, does occur).



When you think about it, however, why shouldn’t the brain be as illness-prone as the rest of the body? It is, after all, the most complex object in the known universe. The brain is better protected than other organs because of its vital importance, but to expect mental illness to be rare makes little sense.

The most recent national study finds that around 9% of Americans suffer depression at any given time. The new CDC study found 11% of us taking the drugs. That sounds like overmedication—except for the fact that other research finds that at least one out of five of these prescriptions are written for non-depressive disorders, ranging from pain to obsessive-compulsive disorder to menopausal symptoms.



Moreover, the same CDC study found that only one-third of people with severe symptoms of depression were taking medication.



The real problem is that depression is wildly complicated, our mental health care system is in shambles and the disease itself often prevents help seeking.  



You feel hopeless and incapable of pleasure; you dread every social encounter. Simply picking up the phone to make the appointment feels impossibly challenging. Worse, even the slightest hint of rejection—like a brisk tone of voice on the phone—can send you spiraling into self-hatred and unreasonable terror.

No one wants to feel like this, and a large percent of people with addiction try to medicate it away. Our problem with depression is that culturally, we think “escaping” this way is wrong. We believe that God inflicts suffering deliberately as a punishment for sin—and, therefore, evading it without “hard work” is cheating.



It’s not. Why should you have to suffer or struggle or work more to recover when the disease itself is such agony? Why should those whose depression has often resulted from early painful life experience suffer not only from their memories, but also the illness it triggered?



Those who've never been afflicted with such trauma aren’t required to struggle with the "hard work" of therapy because they tend to feel alright. So why should the others have to suffer twice?

If a cancer therapy was devised today that did away with the agony of chemotherapy and radiation, we’d be dancing in the streets. So why do we treat the idea of “popping a pill” for depression, rather than crying in a therapist’s office, with such disdain?

The problem with using drugs to medicate away depression isn’t drug use itself; it’s the use of drugs that aren’t effective for that purpose.  Since, however, “fun” drugs do lift mood, people seem to believe that all mood-lifting drugs must be “fun.” And, consequently, that those taking antidepressants must all secretly be addicts.



Of course, anyone who has taken antidepressants knows that the idea that they are “happy pills” is nonsense. The simplest way to explain the difference is this: I sometimes forget to take my Prozac. But I never forgot to take my heroin.

America’s ambivalent relationship with drugs and medication pushes us to ignore critical differences between drugs, while failing to appreciate useful similarities.

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