C’mon Get Happy

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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