Hartford Courant, July 7, 2003.
Why No Reduction In Depression In America?
The Journal of the American Medical Association published a special issue on depression in mid-June. The lead article detailed the results of the National Comorbidity Survey Replication. Although its results were announced as news, the replication actually found largely the same results, and trends, as prior studies of depression.
More Americans report being depressed. We have had a revolution in the United States in identifying and treating depression, searching for its genetic causes and developing new families of antidepressant drugs. Yet we see no reduction in depression. In the recent Comorbidity Survey, 6.6 percent (about 14 million Americans) had a serious depressive episode in the previous year, while more than 16 percent (about 35 million) experienced such depression over their lifetimes. In the first Comorbidity survey 10 years earlier, this figure was less than 15 percent.
Younger Americans experience the most depression. A hoary debate is whether such increases represent actual changes in depression rates or just better identification and labeling of the malady. Yet, the increase in depression is most notable in the young (despite frequent claims that seniors are the group most liable to be depressed). In the current Comorbidity Survey, of those experiencing depression in the previous year, three times as many were in the youngest group (18 to 29) as the oldest (60-plus).
Many more Americans are being treated/medicated. The increase in Americans receiving treatment for depression is striking. Although only a third of those measured as depressed in the previous survey were treated, 57 percent received treatment in the recent study. This increase of almost 40 percent corresponds with data on the rapid, and continuing, growth in sales of antidepressant medications. In 2001, prescription medicine sales grew 17 percent or more in the United States for the fourth year in a row, with antidepressants leading the way (up $12.5 billion, more than 20 percent, in 2001).
The survey claims more people need to be treated with more medication. The thrust of the Comorbidity Survey (as expressed by its lead investigator, Ronald Kessler of the Harvard Medical School) is that although many more Americans were being treated, more people needed to receive treatment, and those entering treatment needed to receive more treatment, including more medication.
However, many people worry about the rapid growth in the psychiatric medication of Americans, especially the young. For example, a study published in 2003 (covering the years 1987 to 1996) found that 6.2 percent of children and adolescents took at least one psychiatric drug in 1996, compared with 2.5 percent in 1987. They were also being treated for longer with the medications.
Although these pediatric drugs included antipsychotics and Ritalin, in 2003 Prozac was approved for the first time for children age 7 through 17. This age group was not a part of the Comorbidity Survey, but will become the youngest cohort in the next replication. We might wonder whether there will be an even more noticeable surge in depression treatment with the 19-29 age group then.
Will the next survey likewise claim that greater numbers of people need to be treated for depression? Already, many observers are concerned about the psychomedication of young (and other) Americans. For example, the effects of these medications on young people have rarely been studied. According to Dr. James Leckman, professor of child psychiatry at the Yale School of Medicine, "we're doing these experiments more or less with our own children."
The Comorbidity Survey and its authors present a continuing portrait of Americans as requiring more and more treatment for depression. Most health professionals endorse this as an advance in public health, but nagging questions remain: Maybe the sources of depression are not under medical control and, by medicating growing numbers of Americans, we are masking the sources of their misery. In this view, encouraging people to recognize and treat the growing incidence of depression in the United States does not represent unalloyed cultural progress.
Stanton Peele, a psychologist and attorney, is the author of "Diseasing of America" (Jossey-Bass, 1999). He wrote this article for Featurewell.com, an op-ed service.