More than 1/3 of American adults take prescription drugs linked to depression | Hacker News Reader

More than 1/3 of American adults take prescription drugs linked to depression

washingtonpost.com

97 pointsyulaow66 comments

The headline is a bit confusing. At first glance it might seem to say that 1/3 of Americans take anti-depressants. What it's actually trying to say is that 1/3 of Americans take prescription drugs that have depression as a possible side effect.

Even that seems bizarre to me. What is the percentage of Americans who take prescription drugs... period? I'm a middle-aged man, and (knock on wood!) still haven't come down with any chronic conditions requiring medication. So I would probably assume that no more than 1/3 of Americans take ongoing prescription drugs at all.

Which means I'd have to presume that pretty much all drugs have depression as a possible side effect.

As I understand it while doing the initial research any time someone says they experienced something on a medication it has to be listed as a side-effect, which is why you end up with "Side Effects may include: naseau, diziness, heartburn, stubbed toes, and spontaneous pregnancy" Given any sort of decent sample size, someone is going to be experiencing depression while under pretty much any medication.

If that's the case, I wish the information would include percentage of cases. 90% side effect of severe depression and 2% side effect of dry mouth is a very different medication than 90% dry mouth and 2% severe depression.

Unfortunately, the typical patient doesn't interpret probabilities very well. Still, lists of side effects often use language like "very rarely".

First, frequency != probability. What negative outcome is expected by sharing the actual values though?

To the extent that probability means anything in the real world, it means frequency. The domain of the frequency is the rub.

Yes, and correlation doesn't imply causation except when it does.

Say, a patient doesn't take an important drug because the 0.001% chance of death seems too large, or alternatively they are falsely comforted by a seemingly-small 1% chance of death.

I don't get it, "seems to0 large" and "seemingly-small" according to who? It seems like you are against the patient doing their own cost-benefit analysis and instead someone else needs to be doing it for them. Who and on what basis?

So, we can first infer that the patient isn't correctly taking the numbers under advisement because they use them inconsistently (e.g., they worry more about four things that are 1 in a million rather than one thing that's 1 in 10 thousand). The question of how to align the patients understanding and actions with what they would do if they had perfect knowledge and intelligence is of course fraught, but one way is to compare medical risks to other risks they understand more intuitively. It's a big topic.

Is that not the case in the US? Every prescription drug I take in the UK has them broken down by "Very common" (>1/10), "Common" (1/10 to 1/100), "Uncommon" (1/100 to 1/1000), "Rare" (1/1000 to 1/10000), "Very rare" (1/10000 to 1/100000), and "Frequency not known" (frequency cannot be estimated from the available data).

I don't think I've ever seen that in the US. Would be useful information to know, though, for sure.

I see that on my prescription brochures in the US.

If you get a tiny print information sheet it has that information somewhere. More conveniently, drugs.com has that information in the professional section of the side effects page.

The inconvenient aspect is that the number of listed side effects seem to inevitably be proportional to how long the drug has been around and how much it has been used and researched, so you also need to have a general idea of all of that if you are trying to figure out which of two drugs is likely to be safer. Also, if two (or more) drugs are commonly used together, the side effects of the combination can be listed on both drugs, even if one of the drugs is most likely primarily responsible.

they break it down into "common" and then various others.

the trick is that most of the ones on the tier immediately after common are actually in the common tier, but they may not have the severity necessary for a patient to report it.

example: chantix(https://en.wikipedia.org/wiki/Varenicline) patient reports ubiquitously report nightmares almost without exception, yet nightmares are listed as a rare side effect because the nightmares might not necessarily be severe enough to mention to a doctor or meet the clinical criteria for a side effect.

As a middle aged man I assume you're not on birth control, a prescription drug whose side effects can include depression. I would not be surprised to find that prescription birth control makes up the lion's share of the third of the adults counted in the article.

Based on my family's anecdotes it seems even discounting even the contraceptive angle, hormonal BC seems to be the crude implement to treating a host of female health issues we don't under stand very well.

Note, copper IUDs (which are non-hormonal) have worked well for all the women I know on it. I’m sure it’s not a panacea, but it’s effective, cheap, and essentially zero maintenance beyond verifying it’s still there.

I believe in some states in the US you can even get the state to pay the cost.

IUDs are associated with a lot of nasty high impact, low frequency side effects.

Birth control is a lot more predictable, especially now that dosages are lower.

Hormonal birth control may be more predictable, but it predictably has bad side effects (acne, weight gain, depression, and a host of other symptoms I’ve forgotten). There are also people where it straight up doesn’t work—one of the women to which I’m referring had two kids on hormonal birth control before connecting the dots and switching.

Overall, everyone has their own birth control needs. Most of the evidence I’ve seen has led me to prompt people having issues to consider the copper IUD because it does seem to work very well (when those complications you mentioned don’t show). A surprising number of people have misconceptions about insertion, periods, hormones, and efficacy, so I’m always happy to increase the amount of power people have over their own uterus by making them aware of their choices.

A certain, cynical part of my brain believes the reason the pill is popular is that there are many, many incentives to encourage people to go a route that returns recurring revenue, not helping women find what works best for them. It seems to be pretty common to simply prescribe the pill when people ask for birth control.

No matter what else is going on, Jimmy always wears his hat when he goes out. The only procedures guaranteed to permanently work as birth control 100% of the time are hysterectomy and bilateral orchidectomy. When you multiply failure rates together, they get smaller.

Don't ignore your inner cynic. Medicine is not the only industry trying to force everyone to a subscription model in lieu of one-time expenses.

What? No. LARCs FTW. Since 2009, ACOG guidelines state they are the first-line option for birth control.

The impact, even of a uterine perforation, is not that high (and the frequency is also lower than you suggest).

tl;dr, the above is FUD.

When you ask doctors what birth control they use IUDs come out pretty high.

www.contraceptionjournal.org/article/S0010-7824%2815%2900072-4/pdf

Cheers!

No doubt contraceptives are a part, but they are actually taken by a small minority of people. They are only applicable to relatively young females, those capable of having children. Younger children and older women aren't much of a market. Depending on what ages you want to pick, the applicable population is probably less than 1/4 the total, with a smaller subset of that actually taking.

A quick googling says that 28% of women of "reproductive age" use the pill, which by my math is about 14% of women overall and 7% of the total population.

What math are you using? By my understanding, women are able to reproduce for around or close to half their lives.

First result[1] I found while googling defines women of reproductive age as 15-49, and claims that group makes up 24% of the overall population, which would line up with my intuition.

[1] PDF http://www.who.int/management/UsingDataToImproveServiceDeliv...

EDIT: Ah, reread your comment, looks like your math lines up with mine, just misunderstood. Thought you meant 7% of the population were women of reproductive age, not that 7% of the population were women of reproductive age on the pill.

Although it also makes me wonder if a sizable percentage of women outside reproductive age are on the pill. Either because they are fertile longer than average, or as treatment for other conditions.

Hormone Replacement Therapy is similar.

- 59% of adults in 2012 take prescription drugs.

- 15% are taking 5 or more

- "One likely factor driving the increased use: obesity."

https://www.washingtonpost.com/news/to-your-health/wp/2015/1...

Just from a bit of googling:

>Researchers find that nearly 70 percent of Americans are on at least one prescription drug, and more than half receive at least two prescriptions, reports CBS Atlanta.

>Researchers from the Mayo Clinic, a non-profit medical and research center, report that antibiotics, antidepressants and painkiller opioids are the most common prescriptions given to Americans.

https://www.cbsnews.com/news/study-shows-70-percent-of-ameri...

Since antibiotics have depression as a potential side effect that boosts the number.

Wonder if that includes birth control? A gender breakdown would be good.

There's an exhibition at the British Museum (http://www.pharmacopoeia-art.net/articles/in-sickness-and-in...) that shows how many prescription pills people take over their lifetime. It's striking how many more pills women take (mostly due to birth control obviously).

Cool to know it's still there. One of the most remarkable things I've ever seen at a museum

of course we live a lot longer than people used to on average. would be interesting to measure how much is from treating problems along the way, vs more healthy hygiene vs childhood survival from sickness.

Birth Control would explain most of the of the OP, wouldn't it?

Much of the rest can be explained by that it's much safer (for the pharma company) to declare an extremely mild/rare side effect than to not declare it. "Depression is a side effect" != "most people who take this drug are depressed"

The vast majority of these drugs seem to be pain killers (unless you count birth control).

It seems to me, given that, the depression side effect is probably related to the following sequence of events:

1) painkillers are given to patients in lieu of actual treatment (you can fix anything with painkillers. With a very low short-term cost and you may get lucky and get a low total cost too (ie. problem disappears by itself))

2) body "adapts" to painkillers, and they, very slowly, become less effective over time

And, boom, there comes your depression.

I have to imagine it's probably closer to 1/2 of people, maybe even a bit more, that take prescriptions. As people age they are much more likely to be taking some prescriptions , I imagine it's quite a large percentage of people over 60. Many women take prescription birth control. Even for people who aren't taking prescriptions long-term, there's probably a fairly large percent of people at any given time that are on some prescription antibiotic, pain killer, muscle relaxer, or some other short-term medication.

A lot of the middle-aged and over are on statins to control cholesterol. I think I started on them in my mid-40s. Various not very old, not very hefty friends are on diuretics for blood pressure.

You are fortunate!

I’ve been on blood pressure control medication since I was 22 (thanks ancestors). As much as it sucks, having a stroke later in life sucks infinitely more.

Just running a quick back of the napkin, because I also think that seems high:

The CDC says that there were 117 million adults with chronic conditions in the US in 2012 and there are 100 million people over the age of 65, the majority of whom (I'm betting) have at least one prescription. Blood pressure medication, anti inflammatories for arthritis, steroids for skin/muscle/hormonal issues, and on and on. That's your third right there. The issues that come with chronic conditions also tend to be more systemic so their treatments are more likely to have impact on brain chemistry leading to depression. I couldn't find CDC stats for children but I'm willing to bet it'd bring the number of people taking prescriptions for chronic conditions to 125-150 million with all the asthma inhalers, ADHD medication, and so on that adolescents get.

Obviously not all of those people are taking a prescription year round and there is significant overlap but I think it's very feasible that two thirds of the country are on at least one prescription between all the chronic and acute conditions. Another thing to consider is that some doctors will write prescriptions for common over the counter medication.

Slightly confusing title, but this is about drugs for other conditions that can include causing depression as a side-effect. Not the percentage that are taking anti-depressants.

A little bit of a vicious circle... 1.) You have symptoms of conditions that are exacerbated by depression. 2.) Buy drugs to treat those symptoms 3.) Drugs exacerbate depression 4.) Get anti-depressants to combat depression 4.) Anti-depressants have deleterious side-effects in other areas 5.) Goto 1

There are also a lot of cases where things like mineral deficiencies cause depression symptoms, and then SSRI antidepressants make them much worse.

And that doesn't include self-medication with alcohol or marijuana and so forth.

I think nicotine use and mental health have a strong correlation also.

Admittedly I 'self-medicate' with marijuana. It has completely transformed me. I used to play video games and basically do nothing, but with marijuana I'm insanely productive.

I'm talking do the 9-5 on coffee only, then go home and worth 4-6 more hours on programming projects.

I have a fanbase for my website, I have transformed my programming abilities, and I've grown a non-profit.

I'm not sure I can work this many hours daily completely sober. My bigger concern is how many years I can work like this. This is year 3.

Would you be willing to elaborate on the dosing schedule you follow?

Sure,

Survive/caffeine through the 9-5.

Nap for 20 minutes(biphasic sleep), I can send you a link for details. Me and the wife have been doing this for years.

Then I have a paxx which holds ~1/8 of g. I'll take that 2-3 puffs. That is usually very light but changes things for 90 minutes.

Then I'll use the paxx to completion. Similar time line.

Then I'll light the toasted paxx extra.

Thats at least 4 hours of focus. I often still need music to get started, but I can totally crush hours of work with the extra energy.

In that regard, I could see it work. How much do you do? If you set aside time to do something, start getting in the flow, and then take a hit... it sort of starts a "new day" mentally because everything is a little more interesting. Then you can pop out a few hours. But with too much I get braindead and just want to listen to music and muse.

Dammit, yet another weirdo ruining marijuana's carefully cultivated slacker image. ;)

I have a friend who reacts to marijuana similarly to what you describe and it still boggles my mind that two people can take the same drug and react in nearly opposite ways.

Anecdote: My mom has never done any drugs etc but first time she caught me smoking she said: "some people do drugs, drugs do most people". I'll never forget and it's true in my experience.

Inanity masquerading as profundity.

Do you use indica or sativa? How do the psychoactive affects not interfere with your productivity? Any memory problems?

Ultimately this is what ended the scheme for me. People started to tell me they'd had the same conversation with me multiple times in a day. That was a full 6 or 7 years before I finally realized I had to stop. On the plus side I started writing things down a lot more, but that only scales so far. It's a dark period of my life I view as an unfortunate mistake that I wish I'd gotten help with earlier.

On the other hand, I did write some remarkable code during that time, code that has lived on and been put into production systems and been relatively bug free and profitable. My method was to get everything I needed ready; source sync'd, computer running, editor open, then and only then dose. Removing all distractions at the start was key. I could not, however, imagine actually learning how to code, under those conditions.

My bigger concern is how many years I can work like this. This is year 3.

Really depends on the person. What I noticed halfway year 2 or so already is that the productivity gain was like 50% or lsess of what it was in the beginning (I did use already before that, but was studying then - sidenote: a small dose worked extremely well to completely kill any pre-exam stress I always had and my grades were better than ever). Worse, the creativity which was basically what I did it all for went down even more. Only way to get that back was not use for a week or so. Quit after year 5 but by that time other substances had come into play as well and things weren't too good anymore. I don't think I could still work those insane hours sober every single day, but I also wouldn't want it: there is so much more to life than just work/party.

I've come to really enjoy pot since graduating college. For the first two years out of school I began smoking daily - largely for self medicating purposes. I eventually had to take a break because I found my relationship with the substance unhealthy and basically became a lazy pot head with my head in the clouds even when not high. I do want to re-introduce pot into my life because I do really enjoy the mental state and it helps me get excited about learning physics and math after work which is something I try to push my self to do. I think, ultimately, my issue is moderation. If a smoke a little in the evening before diving into a subject there isn't really anything stopping me from just getting blazed and watching youtube videos - which would be fine if it didn't completely dull my mental edge the following day. I look forward to retirement where I can just go full pot head.

That's awesome. I personally used to be a daily smoker (like start the day with a bowl, end the day with a dab type smoker). It definitely was insanely beneficial for me at first. After about 5 years, it lost its magical effects for me because my tolerance was too high. I took an extended tolerance break and when I came back, something still wasn't quite right and I've been sober ever since. My productivity has increased and I'm feeling a lot better.

I hope cannabis continues to work well for you. For me personally, I hit this wall at around 5 years of daily smoking. I can't imagine how my life being on it's current trajectory without it though. It really was a big boon to my creativity, productivity, and life.

For those who have never tried or have only used prohibition era cannabis, sativas and indicas have significantly different effects. With the ability to choose your strains, you really can craft your experience. Cannabis can be a very powerful tool. Also, please, don't take this as an endorsement to go out and try it. That's a very personal decision in my opinion like whether to consume alcohol or not.

>> "The study analyzed a detailed survey of thousands of American adults taken every two years between 2005 and 2014, in which people opened their medicine cabinets and showed researchers all the prescription drugs they had taken in the last month."

So the methodology and therefore tittle is a little misleading. This is about people who have been prescribed something and have taken it in the last month. Those taking prescription drugs without a prescription probably don't admit this in surveys. All the off-prescription opioid addicts are not represented. The title should be that 1/3 of Americans have been prescribed drugs.

I'd rather see data from pharmaceutical manufacturers. I'd be interested in how many tons of depression-linked medication is being consumed, from which we can estimate the total number of 'prescriptions' that are active. That would cover the off-prescription consumption too.

Do 1/3rd of Americans need to take prescription drugs on a regular basis? If that's the case then alarm bells should be going off even if they're not depression related.

Clickbait headline. Not article refers drugs which may have some correlative relationship with depression (e.g. side effects may include), not drugs associated with treatment of depression.

I also mis-read the headline, but that doesn't make the headline incorrect.

Not incorrect, just clickbait.

I'm not so convinced; “linked to” is absolutely bog-standard for correlation. The interesting thing is how much more we're primed to read it the other way even with relatively unambiguous language.

fix the goddamn headline

how about: people are already depressed and having sketchy, addictive drugs pushed on them by a large profit-driven medical industry will not fix the real issue?

The headline doesn't seem to be about antidepressants.

They didnt include caffeine? I've read that caffeine is one of the best drugs for reducing depression.

Note: I have a love/hate relationship with caffeine.

This is just "prescription drugs" which excludes caffeine.

This is a curious issue, clearly this is a problem. Having 1/3 of your population depressed is IMO near a crises. However, how would a government or a body of people act to fix this? Aiding people with tax breaks may not even be touching the issue due to the nature of depression.

What can a governing people do to make it's people not miserable except for handing out happy pills?

Reading the article reveals that you have fundamentally misunderstood the issue here. The first paragraph of the article states:

> More than a third of American adults are taking prescription drugs, including hormones for contraception, blood pressure medications and medicines for heartburn, that carry a potential risk of depression, according to a study published in the Journal of the American Medical Association.

Not on "happy pills," but on medicines that may lead to depression as a side effect.

Reply on news.ycombinator.com