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Drugs Not Always a Cure for Depression

Pharmaceutical Industry's Promises Can't Always Be Trusted

By Tom Glaister
ConsumerAffairs.com

October 10, 2006

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Editor's Note: This article reflects the author's personal opinion. If you are suffering from depression, you should consult a psychiatrist, psychologist or other mental health professional.

A couple of years ago I was feeling pretty down for a while after a dysfunctional relationship had finally bitten the dust and I decided to get some professional guidance. I tried to let go of all my preconditioning about Freud and leather couches and went to see the shrink that my health insurance covered me for.

My psychiatrist heard my tale of woe -- my difficulties in getting out of bed in the morning, the fits of rage where I would throw the remote control at the TV set -- and she nodded wisely.

"I want to try you out on Prozac and we'll take it from there." She told me with a sage nod of the head.

When I asked her how a pill was supposed to heal my heart, she began a long-winded explanation about the chemical balance of the brain, serotonin uptake and the need to take a modern perspective on psychological suffering. I grinned, decided to be old-fashioned and went to find someone who was actually interested in talking things through with me.

Tom Cruise made the news recently when he criticized Brooke Shields for taking antidepressants, called pharmacology a "pseudo-science." He was half right but then unfortunately came to the conclusion that Scientology offered something better.

Pharmacology is not a "pseudo-science" but it is a science that is still in its infancy. Antidepressants do manifest changes in those that take them but doctors can still only make a best guess as to why and the side effects can be worse than the original complaint. For one thing, most SSRI's (selective serotonin reuptake inhibitors -- the most-marketed kind of antidepressant) cause sexual dysfunction in males -- a good enough cause for depression if ever there was one. Alarmingly, they also show evidence of causing violent behaviour or even suicidal tendencies in the people who take them.

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That antidepressant medications may be associated with suicide attempts and death in severely depressed children and adolescents was confirmed in an August article in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals. The study did not find a similar association in adults, although a Norwegian study found a greater suicidal tendency in adults talking Paxil.

The U.S. Food and Drug Administration last month finally began requiring drug manufacturers to include a warning regarding the risk of suicidal behavior among children and teens treated with antidepressants.

Not that the pharmaceutical companies would like you to hear about that kind of thing. For years the big companies merrily cited the FDA finding that Prozac didn't cause urges to commit suicide and was quite safe. Of course, no one mentioned that the FDA findings were based on studies conducted by Eli Lilly scientists -- Prozac's manufacturer.

As antidepressants generate about $8 billion a year, one might intuitively wonder if there was any pressure on the scientists to present favorable data. The career of a research scientist pretty much depends on the backing of the big players in the pharmaceutical industry as they're the only ones with the cash to run clinical trials in the first place.

No doubt there are researchers with a strong enough scientific discipline not to bow to commercial pressure, although a new study indicates that studies underwritten by drug companies tend to reward their sponsors handsomely. Indeed, the original scientists testing the safety of SSRI's seemed to overlook danger signs spotted by others. Authorities in Britain ended up roundly rejecting two University of Texas studies investigating the effects of the antidepressant Paxil and Zoloft on children.

The evidence that children were being put at risk led British authorities to place a near-total ban on the use of SSRI's in children, a move that the FDA followed with an "advisory" to physicians. Yet, ultimately, it's still at the discretion of each doctor in America to prescribe what they see fit.

Doctor Knows Best?

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But why would you ever want to doubt the recommendation of your doctor? After years of medical training and taking the Hippocratic oath, surely they know what's best for you?

I used to think so, too, until one evening when I met a guy called Jerry, sitting at a bar staring forlornly into his beer.

"If the beer doesn't work you could always try Prozac!" I quipped and he turned to meet me with an ironic smile. It turned out that he sold the stuff. That is, he was a drug rep, one of the 68,000 "routemen" for the pharmaceutical companies who spend every working hour trying to convince doctors to prescribe their drugs as often as possible.

And in a free market, why not? After all, why would a trained doctor be swayed by the sales pitch of someone with no medical background?

"We bribe them," Jerry grinned. "Or rather, we emotionally blackmail them by taking them out to dinner in the best restaurants, take them on vacation, that kind of thing -- I even got one shrink seats to the Super Bowl. Then the next time I'm on the phone to them they feel obliged to do me a good turn by ordering my pills."

While I could imagine there might be some doctors out there who would feel like returning the favor, I supposed there must be enough medics who really knew their stuff and would just take the free lunch and go.

"True," Jerry nodded, "You get some really arrogant doctors who don't feel guilty so then I switch tactics and play to their egos. I ask them if they could help me out with some information at least and ask them to tell me about the antidepressant I'm selling -- they all want to show off and they end up selling themselves the drug!"

The greater part of the medical establishment sees nothing wrong with the current set-up. There are even some doctors who feel that the drug reps are doing them a favor -- they collect all the most recent info and put it all together in a neat package, saving the doctors from wading through a pile of research. They dismiss any allegations that they're swayed by all the pizza deliveries to their clinics by reminding you that they're in one of the most intelligent professions in the world and aren't easily swayed by a few free gifts and some aggressive marketing.

"Idiots." Jerry grinned, ordering us both another couple of beers on the drug company's bill. "Do they think that we spend billions of dollars every year on changing their minds for nothing? Now come on, drink up -- if we don't spend at least $100 my boss will never believe I've been drinking with a doctor."

A Spoonful of Sugar

Leave it to the free market to get the drugs to the doctors, but do they work? Can cases of anxiety and depression be cured by swallowing a pill every day like a religious sacrament?

Apparently so, at least according to drug company research that's come to light showing that placebos -- sugar pills -- scored as well as the antidepressant in more than half of the trials made. The result being that the makers of Prozac, Zoloft and Paxil had to run trial after trial until they finally came up with enough positive results to market their drugs.

It's worth noting, too, that in the clinical trials patients received a lot more care and attention that in their average 20-minute visit to a doctor. In many cases, it may have been that the actual human attention was enough to give the sugar pill (or antidepressant) the kick it needed to bring about change.

A Modern Epidemic

Depression is a distinctly modern epidemic.

While the vaults of literature show anxiety and moodiness to be an ancient part of the human condition (would Othello have been so murderous if he'd been on Zoloft?), recent research show that depression rates in Americans have increased with each generation and doubled since World War II. And it's not just an American condition -- rates of depression have soared dramatically in the developing world too, despite massive improvements in health and living standards.

So what's going on? How come we're feeling so down when life is getting easier and easier with each new wave of technological labor-saving gadgets and social freedoms that would have been unimaginable 50 years back?

There's a mounting suspicion that it's our modern culture that is at the root of the depression phenomenon. When I first came to California, I was struck at the somber feeling in some of the Mexican neighborhoods I visited. Where were the smiling faces and relaxed attitudes that I knew so well from my time in Central America?

Recent studies by a researcher called William Vega have shown that while Mexicans have far better resistance to depression, anxiety and drug use when they arrive in the US, after 13 years of living in the country they become as susceptible to malaise as other Americans -- and their children are far more likely to suffer from severe depression in their lifetime. The same patterns have held true for research into other immigrant communities to the US.

So are we still looking at a chemical balance to blame away the blues or is there something at the heart of American culture and (god forbid) the American dream that is at fault?

The truth may be that the roots of much of modern depression aren't peculiarly American but they are intimately linked to the changes in lifestyles and culture that have affected us all in the last few decades.

Many of us now go to work everyday to labor in a cubicle with only a PC for company, we drive home alone in our cars, we shop at malls where our only meaningful interaction was with the greeter at the gate, and then we go back to live alone in our apartments and try to find some intimacy via a dating site or chat room.

This lost-in-the-crowd way of life was labeled "Bowling Alone" by Robert D. Putnam, a Harvard professor and social critic, in his book of the same name.

We've lost the extended family structure and psychological good health that I've seen in places like India and Brazil where people are much happier with much less. We have all the luxuries we could want but at the same time have forgotten some of the basic human needs to keep us with a smile on our faces.

Admittedly, there do exist cases of extreme depression where antidepressants may well be worthwhile, at least as a temporary salve.

However many mild cases of malaise can be effectively treated by getting more exercise, eating a diet rich in fruits, vegetables and nuts and spending more time interacting with other people. We evolved as social creatures for the last few hundred thousand years and so it's hardly surprising that we're feeling blue in a culture suddenly intoxicated with individualism and isolation.

It's worth repeating the maxim that not only do the best things in life come for free, they also can't be sold. That's why you'll rarely hear the drug company reps advising medics to try out their patients on a 20-minute stroll a day followed by lunch at the raw food salad bar -- rather than recommending a course of SSRI's.

Tom Glaister is the founder and editor of www.roadjunky.com - The Online Travel Guide for the Free and Funky Traveller.

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