Washington, DC — Last summer, I was at the doctor's office for my annual checkup. All was going well when the doctor asked my mom to leave the room, closed the door and explained to me that she was concerned. I had scored low on the mental health survey they had given me. It was likely I had depression.
I was not surprised, I’d been going to therapy for two years at that point and I’d been managing things. My doctor seemed pleased at this news, but then added, “You know, if you ever want a little help with getting those feelings under control I could prescribe you some medicine.”
As it turns out, this is not an uncommon experience. An estimated 1 in 7 Americans were prescribed antidepressants as of 2016, and this number has only risen since. This is a huge and worrying number, however, these statistics don’t quite show the full picture.
Seventy-nine percent of antidepressants are prescribed by primary care physicians. This means millions of patients are being prescribed mood altering drugs by doctors who have no specialty training in psychiatry. Not only do these doctors not have particular expertise in this field, but primary care physicians tend not to spend much time with patients. The average appointment time with a primary care physician lasts around 15 minutes. With such short visits, it seems pretty unlikely that a doctor would be able to get a realistic understanding of a patient’s mental state. At least not enough of an understanding to merit a prescription of medicine for such a complex condition as depression.
Both of these factors can lead to the over-prescription of antidepressants, but it’s hard to say exactly how many patients are being affected by this, because depression is a hard thing to quantify. Depression is generally defined as a repeating feeling of sadness, despair and to some degree hopelessness without a definite cause that persists for over two weeks. This is a pretty abstract concept, and it takes a lot of time and expertise to diagnose its existence and severity in a patient in order to best treat it.
So, it's hard to say for sure how many people in America are being unnecessarily put on antidepressants, because it’s hard to get data on who exactly is depressed and to what degree in the first place. One thing seems pretty clear even without exact statistics. If millions of people are being prescribed antidepressants by primary care doctors with such little knowledge and time, then it's likely that at least some of those patients probably don’t really need to be on the medicine.
But what’s the issue? Sure, there appears to be some degree of over prescription, but it can’t hurt right? If anything, don't antidepressants make people feel better? Well not entirely.
Most antidepressants are SSRIs, or selective serotonin reuptake inhibitors. Essentially, they increase the levels of serotonin in the brain which, in most cases, leads to lessening symptoms of depression or anxiety, however, that isn’t all they do.
This fall, at the beginning of the school year I had my worst depressive episode yet. I became almost dysfunctional, and eventually, at the suggestion of my therapist, I visited a psychiatrist and got prescribed 10mg of Prozac every day, the lowest dosage. It has been helpful, I’ve been able to stabilize my mood. I don’t feel so overwhelmed and helpless. I can function again, but I’ve also noticed some other changes, almost a numbness. While I feel a lot less sad, I feel a lot less happy too. I can’t remember the last time I really enjoyed a song, or got genuinely invested in a movie. While I haven’t cried in months, I haven’t felt a lot of joy either.
This numbness I’ve been experiencing is referred to as emotional blunting, where patients' negative emotions are dampened but so are their positive ones. According to a recent study around 40-60% of patients on SSRIs experience this phenomenon.
For me, taking antidepressants was the right choice. My depression was bad enough that it required some medical intervention, but for the patients prescribed antidepressants carelessly who might not fully require them, this side effect could prove to be worse than their actual symptoms.
I don’t mean to imply that this issue is the doctors' fault. Primary care physicians are overworked and stretched too thin already. It is unfair to expect them to give a perfect diagnosis on something as complex as mental health each time. Really, the only doctors who should be prescribing antidepressants are physiatrists, but many patients cannot access or afford physiatrists in the United States.
Furthermore, antidepressants are often prescribed to patients with less severe depression who would benefit from more moderate treatments such as therapy but can’t afford it, and end up on SSRIs that might be unnecessarily strong.
So, the issue with antidepressants is merely a symptom of the broader issues in the U.S. healthcare system, but that does not mean that there is nothing anyone can do.
The best thing anyone – patients, doctors and really all people – can do is to raise awareness that antidepressants are serious complex medicines with side effects. Antidepressants aren’t all bad, but they aren’t entirely good either. No medicine is, and it’s dangerous to treat them and prescribe them like they can do no harm.
Antidepressants aren’t a miracle cure, because they aren’t a cure at all. It’s not at all a perfect solution, but the more we take antidepressants seriously, the more informed patients and doctors become, and the better safer choices they can make.