A Third of Antidepressants Are Prescribed for Something Else
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Pfizer were fined $2.3bn for off-label promotion of Bextra, Geodon, Zyvox and Lyrica. Eli Lilly were fined $1.4bn for off-label promotion of Zyprexa. GSK were fined $3bn for a slew of misconduct, including off-label promotion of a dozen drugs. AstraZeneca were fined $520m for off-label promotion of Seroquel. Abbott were fined $800m for off-label promotion of Depakote. Novartis were fined $422m for off-label promotion of Trileptal.
Despite these huge fines, the unlawful marketing continues. I don't think we're taking the issue nearly seriously enough. For years, drug companies have been telling (and even bribing) doctors to prescribe drugs with serious side-effects to vulnerable patients based on no real evidence.
There's a deep malaise at the heart of the pharmaceuticals industry. Marketing has become the core function of many drug companies. Blatantly fraudulent marketing is endemic. Drug companies are chalking up billion dollar fines as a cost of doing business.
I urge you to read the GSK settlement agreement. They admitted to promoting the prescription of Paxil to children, while having no evidence of efficacy and hiding evidence that it increased the risk of suicide. They admitted to hiding evidence that Avandia increased the risk of congestive heart failure and myocardial infarction. They admitted to bribing doctors to prescribe half a dozen drugs for off-label use.
This level of corruption would be outrageous in the developing world, let alone the richest country on earth.
https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-...
Being sad and unable to leave the bed because (your dog died | you are morbidly obese | you are going to die in 3 months) doesn't qualify as depression.
So back to your example: Not leaving the bed because your dog died can be a red flag of depression. Or cause it in a few people (death of significant other, parent, or child is probably more likely to cause it though). This is especially true the longer the person has the symptom - none of us would blame a person for taking a couple days off, but you should be able to function at work a few days later.
It doesn't matter if obesity is the cause of the depression if the state of mind keeps them from doing self-care.
And I don't know why it would be bad to let some terminally sick person to take happy drugs. It seriously doens't matter at this point because they will probably be dead. Might as well enjoy what you can of the rest. This is probably a bad example all around and likely hard to diagnose properly.
Any active medication has side-effects. But if the depression—even though it may have an unknown cause—prevents a person from functioning in life, then the medication might be worth it. But it's a judgement call to be made by the patient, with proper guidance by his/her care team. In many cases, increasing the risk of a severe disease 20 years from now is preferable than losing job/house/life. It's easy to criticize these patients or their care team as doing too little but sometimes, a baby step is the only realistic step that can be taken, and there may even be some urgency associated with it.
Having said that of course, it's important to follow-up and continue to dig deeper in what can be done from a mental health perspective. An antidepressor may be the band-aid to regain sanity and some stability, and from that place, the next steps can be taken. The key is to not give up in that journey towards health, but that is easier said than done.
Disclaimer: not a doctor, just a patient advocate.
In fact, I believe using antidepressants for such cases is counter-productive, making people rely on pills to feel alright instead of acquiring the adequate coping mechanisms or mental processes.
Giving drugs (whatever their legal status) to terminally ill patients is acceptable, but it's still not treating any illness known as depression.
Okay, so it can be addressed, using therapy, like depression. What would you prefer to call it?
Conflating depression with "being sad" is to misunderstand what depression is, what sadness is, and how we qualify depression diagnoses. Sadness is natural and healthy. Depression is natural and unhealthy.
While the word 'depression' is abused in pop culture, showing enough symptoms of major depressive disorder over a long enough timeline is the literal textbook definition of being depressed.
Not getting out of bed because your dog died is arguably a natural reaction to sadness. Not getting out of bed for three months, refusing to eat because you're trying to die, cutting off lifelong friends, and undergoing severe personality changes because your dog died is really, really, something else.
And, on a personal note, distinguishing between what is and isn't a "real" cause for a feeling is a pretty offensive judgment and implies a very dismissive attitude towards peoples pain... I mean, someone who is unable to function in society 15 years after their kid died doesn't get to be depressed because they have a "real" reason to feel bad? And people who kill themselves from a major cognitive imbalance don't have a "real" cause for feeling that way? Bleh. That's a half step removed from "suck it up" or "snap out of it".
Unfortunately I am very aware of most of the symptoms of depression as I have suffered it myself in the past. And yes, I did take antidepressants. I am not against their use at all, only against misdiagnoses.
15 years of mourning the death of a loved one is of course abnormal, as I have stated already in another response around this thread, but... is it depression? Or is it lack of coping mechanisms? Maybe learning to face reality is better than depending on a daily dose?
Do you mean no cause other than a chemical imbalance? I still think that's shaky ground, but I don't really know enough to say.
Anti-depressants are one tool for treating depression, but they’re usually not meant to be the only tool and ideally people would usually not end up on them indefinitely.
Code 296.21 designates the apparently paradoxical diagnosis of Mild Major Depressive Disorder, with the following description of severity:
Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
Essentially, the DSM-5 creates a specific diagnostic category for people who are basically OK but slightly sub-par. That's not inherently dangerous in isolation, but it does interact very dangerously with the persistent malpractice of the pharmaceutical industry. Someone who might just need some low-intensity psychotherapy or some peer support might end up on an indefinite SSRI prescription.
Several meta-analyses have indicated that SSRIs are not significantly more effective than placebo in mildly depressed patients, with a significant frequency of adverse events. Most SSRIs have known "discontinuation effects" (e.g. withdrawal symptoms), making SSRIs a distinctly questionable choice for mild or short-term depressive episodes. Despite this, there has been a vast increase in the number of SSRI prescriptions, with most of the growth occurring in patients who historically would not be considered sufficiently impaired to warrant drug treatment.
10% of Americans over 12 are currently taking antidepressants, rising to a staggering 23% of middle-aged women according to the National Center for Health Statistics. There is a huge racial disparity, with 13.6% of non-Hispanic whites taking antidepressants versus 3.9% of non-Hispanic blacks. Less than a third of people taking a single antidepressant have seen a mental health professional in the past year.
Something is seriously wrong with the way we diagnose and treat depression; I lay the blame almost entirely at the door of pharmaceutical marketers.
You're making a justified/not justified appeal to the scope of diagnosis, not that diagnosis exists/does not exist on the basis of "reasons". As a taxonomy the code system in the DSM is broad, inclusive, and tries to hit a meaningful subset of behaviour in range of darned tricky, poorly defined, near-impossible to STEM-style research, and abuse prone issues.
More importantly, the reason there will be a DSM-6, DSM-9, and DSM-111 is because these codes will specialize and refine themselves over time...
> Essentially, the DSM-5 creates a specific diagnostic category for people who are basically OK but slightly sub-par... might end up on an indefinite SSRI prescription.
The fact that a diagnosis exists or not is orthogonal to treatment method. The DSM is like the Dewey Decimal system of "head stuff", inclusion in it's indexing is proof and support only of inclusion in its index. Mein Kampf is as much a book as my self-published wookie fan fic, IOW ;)
Crappy medication from crappy doctors is a big deal, and crappy use of prescriptions kills a lot more people than any of the fun drugs... Regardless, bad treatment or good treatment do not hinge on subjective qualitative judgements of your experiences. That's how priests operate, not doctors.
> Something is seriously wrong with the way we diagnose and treat depression;
The US is a notorious abuser of pharmaceuticals across the board, with notoriously bad diet, nutrition, weight, and health system... Something is seriously wrong with the way you treat all your sick people, and design your cities, and make your food, and treat your environment...
There is especially something wrong with how you advertise pills constantly as though they can heal with powers otherwise reserved for healing lepers and converting water into nicely refined chianti...
This still doesn't mean you are only by-textbook-defition depressed if you have a "reason". You don't have to justify leukaemia, schizophrenia, bulimia, aspergers, or chronic asshole-itis, why should depression be any different? If you're statistically abnormal, you're statistically abnormal. No one in crushing pain needs to convince, debate, warrant, or validate anything for a doctor and healthcare system to understand that their anamnesis correlates with a particular taxonomy. In fact, that's kind of a jerky thing to demand of someone experiencing psychic distress and looking for help...
The most successful so far is an anti-depressant. Duloxetine. SNRI. I do have some of the side effects - my libido is markedly decreased, but it was fairly high to begin with, so I'm probably at about low-average now. I can still get in the mood on demand, and still want to initiate several times a week, so I'm more than happy to make the trade off to not have a basically constant headache 80% of my waking hours.
Off label prescription is a pretty common thing. Personally, I'm glad for it.
I'll check out Curable though, thank you!
This is a small data point but who knows, not sure how recently you started taking the meds but there is a chance all the side effects will vanish :)
The side effects are pretty mild, though if I miss a dose the headache I get after is usually amplified.
There's definitely a relationship, though - high blood pressure can cause headaches
So if I were given SSRI to quit smoking, my mental health may get even more worse.
Disclaimer: have bipolar and personality disorder.
As somebody who's been suffering from depression his whole life, atop a few other mental issues, it's really disheartening to realize how little we seem to actually know about how the human psyche and brain work.
[0] https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...
Once you test something out on enough people it becomes much easier to find these patterns of secondary effects.
It is actually kind of unfortunate that because of the stigma associated with mental illness some patients will refuse to take anti-depressants when prescribed for other conditions where they could be helpful.
Trazadone is one of the most commonly prescribed insomnia medications. It isn't FDA approved for that. It is a decade's old generic antidepressant. The sleep dose is much less than the regulated theraputic dose.
Through mechanisms not fully understood, people with liver disease often experience intense skin itching. Standard dermatology approaches have essentially no effect. SSRIs are one well tolerated treatment.
In neither case is their obvious profit motive or overselling by drug companies.
I always say to be wary of treating symptoms instead of underlying causes. Taking an antidepressant to soothe intense skin itching can kill you, if that's all you're doing for it. Your dermatologist may not know any better, or may not care.
I suspect there's a link in some form of branch of depression that comes with the autoimmune grab bag of fun.
"On occasions when she stopped taking bupropion, the blood and abdominal pain returned until she started taking the drug again."
Yet I guess I am unimpressed when I hear that symptoms diminish with use of a drug like bupropion. Eventually when the patient gets tired of the side effects they will get off the medication. This will leave them with the return of the illness they used the drug to treat in addition to the damage it caused in other parts of the body. Masking symptoms is sort of psychiatry's gambit so I guess this is nothing new.
Ginger is also a very powerful antihistamine - comparable to drugs - with fewer side effects, however.
I have the opinion that most people should use antidepressants.
As far as the reason it seems to work, that was given as:
>Studies on mice had shown that instead of blocking the action of inflammatory proteins, bupropion appeared to lower the production of those proteins in the first place.
Bupropion also FDA approved for weight loss when mixed with the opioid antagonist naltrexone (brand-name Contrave).
No use "make sense" more or less than any other use use, it's a substance that has lots of effects on the body.
It was twenty some years ago when I took it. I obviously haven’t kept up with the latest, but a quick search says FDA approval came shortly after it was prescribed to me. Mea culpa.
And thanks for the answer.