C'mon Get Happy

The quiet take over of mood medications

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Prozac's alive and kicking, reports Judith Newman in Mirabella (Sept./Oct. 1995), ringing up nationwide sales of over $1.2 billion, making it the second-biggest moneymaking drug in the US. Prozac's priceyness is put in perspective by one sci.med.pharmacy poster -- at $100,000 a kilo, it's much more expensive than cocaine. Newer antidepressants such as Serzone, Effexor, Wellbutrin and Paxil, Zoloft and Luvox also have fueled a record sales rise of 45 percent combined a year, reports a bulletin on Effexor. Meanwhile, the rate of clinical depression remains steady at 10 per cent of the population, estimates the National Institutes of Mental Health. While Newman doesn't question the 'enormous good antidepressants have done,' she wonders whether there are 'just a lot more people who believe reality won't bite if they take a pill?'.

For those tempted to treat more garden-variety unhappiness with antidepressants, there's considerable sentiment to accommodate them. A sympathetic family doctor can supply the goods; Newman notes that the majority of antidepressants are prescribed by non-psychiatric physicians. Non-MD psychologists are fighting for the legal right to prescribe drugs, upsetting critics who say extensive medical knowledge of drugs' physiological interaction should be required. Further more, current cost-cutting health care policy encourages the use of pills -- a 1993 study of psychologists showed 27 percent were forced to prescribe drugs over more expensive talk therapy. Drugmakers such as Prozac producer Eli Lilly (co-sponsor of the National Depression Screening Day on Oct. 5 -- mark your calendar! -- are always looking for new uses, Newman says. Lilly's latest Prozac cure-all is PMS, while Wellbutrin's being examined for smoking cessation and Paxil for premature ejaculation.

What's driving this trend? Part of the appeal of pill-popping is rooted in the increasingly popular view that mental illness is biologically based, writes critics Seymour Fisher and Roger P. Greenberg in Psychology Today (Sept./Oct. 1995). The two veteran psych profs complain that some biological psychiatry fans are so convinced that unhappiness results from physical malfunctions of the brain that they're urging young shrinks to skip psychotherapy training and learn 'scrip-writing instead.

Yet when the two authors examined the evidence, they found that the bottom-line question -- do the drugs work? -- must often be answered 'no.' Their overall research showed that overall, one-third of patients did not improve with antidepressant treatment; one-third improved with placebos, and one-third responded favorably. The placebo research was revealing -- some takers reported significant side-effects, even addiction, to the inert sugar pills. This placebo effect along with the low efficacy rates for drugs argues strongly against the biological basis for mental illness.

So should drugs be avoided? Fisher and Greenberg say no, but they do recommend avoiding antidepressant use at the first sign of depressive distress. 'Depressed feelings have complex origins and functions. In numerous contexts -- for example, chronic conflict with a spouse -- depression may indicate a realistic appraisal of a troubling problem and motivate a serious effort to devise a solution,' they say. Quickly popping a pill 'could interfere with the potentially constructive signaling value' of unhappy feelings.

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