In the 1950s and '60s, only people with severe symptoms were labeled as depressed. The drugs used, tricyclics, says Rudorfer, were "potentially toxic to the heart and extremely dangerous if you overdosed on them. Anyone who took these drugs required a lot of time and attention from physicians—repeated visits and regular dosage adjustments. Prescribing them was generally restricted to psychiatrists. They were used in anything but a casual fashion."
Since the late '80s, when the new antidepressants started hitting the market—SSRIs, which boost serotonin, and related drug classes like SNRIs that also affect other brain neurotransmitters—the medical community has been prescribing them without a psychiatrist's input. As a result, according to The Wall Street Journal, 75 percent of prescriptions for antidepressants are written today by primary care physicians, most of whom have little training in diagnosis and management of psychiatric disorders.
Meanwhile, there is no shortage of patients. In June, a much-publicized survey funded by the National Institute of Mental Health suggested that one in four people experiences a mental disorder during any given year, and half of Americans will have one during their lifetime. How, as a nation, have we come to suffer such a widespread psychological affliction?
"I expect we're going to find that the definition of mental illness has been too broadly drawn," says David Kupfer, MD, chairman of the department of psychiatry at the University of Pittsburgh Medical Center and extremely influential in his field. "When I heard about the results of this study, I thought I'd be spending all my time taking care of patients."
With antidepressants now being used to treat not only depression but an ever-expanding variety of conditions (shyness, eating disorders, premature ejaculation, sexual addictions, smoking, premenstrual syndrome), they've almost gained the status of all-purpose wonder drugs. As Andrew Solomon, the author of The Noonday Demon, a brutally honest and much-heralded tome on depression, noted in a recent article, there are "people with an inflated idea of how happy we should be, who want to medicate away their personalities." My question is: At what cost?
I began to check with clinical psychologists and psychiatrists as well as psychopharmacologists (experts at prescribing psychoactive medications) and academics studying patients and drugs. Charles Nemeroff, MD, chairman of psychiatry and behavioral sciences at Emory University in Atlanta, who has spoken on behalf of several antidepressant drug companies, estimated that between 15 and 20 percent of his patients on medication complain of emotional blunting, although most would prefer that to severe depression. "Someone will say that she loved to play the piano, that it was her greatest pleasure in life, but that she can't get interested in it anymore."
Harvard's Glenmullen, whose books Prozac Backlash and The Antidepressant Solution both address the side effects of these drugs, added, "We've known about cognitive side effects of SSRIs for more than a decade. Often they creep up slowly. And if nobody's watching, the patient can make all kinds of assumptions about the nature of these changes—that this is who he or she has become."
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