Unbiased Analysis of Today's Healthcare Issues

Anti-depressants and Fiscal Stimulus

Written By: Jason Shafrin - May• 13•10

Conventional wisdom holds that physicians can use anti-depressants to treat long term depression.  Many patients, however, spend years or even decades taking these drugs.  Is this how the inventors of anti-depressants believe they would be used?

Author Robert Whitaker believes not:

You find that even with major depression, in the pre-antidepressant era – and this is depression so severe people were hospitalized – they could expect to get better. The episode would eventually pass.

… So when antidepressants were introduced, the thought was okay, we really can hope to improve on this sort of natural recovery, but maybe we can help people recover quicker? So that really was the rationale for the use of antidepressants.

But it’s really interesting if you follow this course through, forward in history. The minute they start using antidepressants in any sort of large numbers, doctors start saying, “Well, you know, my patients may be getting better, the depression maybe lifting faster, but then we’re noticing that they’re also relapsing more frequently than before, back into depression.”

So right away you get this question: Does the drug treatment actually put people on a more chronic course than before?”

This reminds me of government “temporary” spending programs.  In times of fiscal crisis, the government often institutes temporary spending packages to revive the economy (e.g., the Stimulus Bill or ARRA).  Although these actions may help revive the economy in the short run, in the long run they often lead to reduced growth prospects.  Oftentimes, however, as the status quo changes, entrenched interests make it difficult to repeal a bill.

Similarly, giving someone anti-depressants changes the status quo from one of a non-drug user to a drug user.  Physicians become accustomed to treating the patient with drugs and many believe it stabilizes the patient.  Further, the patient often experiences withdrawal symptoms if they attempt to change their status quo from that of a user to a non-user.

Mr. Whitaker also cites a Duke University study from the 1990s examining 3 patient groups: 1) Exercise only 2) Exercise plus antidepressant 3) Antidepressant only.

After six weeks, the drug-only group was doing slightly better than the other two groups. However, after 10 months of follow-up, it was the exercise-only group that had the highest remission and stay-well rate.

Both anti-depressants and stimulus packages offer short run relief for the patient or economy.  Excessive use of these short run measures, however, leads to worse outcomes in the long run.

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7 Comments

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  2. Lisa says:

    I love this post. As a clinical psychologist, I can really appreciate how ineffective antidepressants seem to be in helping people overcome depression in the long run. These meds are now handed out to patients like candy in the absence of appropriate evaluation.

    Thank you, thank you, thank you for mentioning Dr. Blumenthal’s SMILE research study, wherein aerobic exercise proved to be more effective than Zoloft in treating depression. The UK utilizes exercise as a treatment for depression but sadly, the US lags far behind on this research.

  3. […] that keeps coming up in health care reform is the idea of reducing health care costs, I found Jason Shafrin’s post in this week’s Cavalcade of Risk to be especially interesting.  He cites a Duke University […]

  4. […] that needed change doesn’t happen.  Here is a very interesting article comparing the antidepressant medication trend with economic stimulus bills.  It’s both thought provoking and humorous to read since both temporary solutions seem so […]

  5. OpenUri's says:

    There was probably not much wrong with Melissa Huckaby mentally until the community mental health system got a hold of her from her shoplifting conviction. She was diagnosed with depression (probably b/c her husband abandoned her and their child and never paid support.) She should have been diagnosed with poverty. At the time of the crime she had in her possession prescriptions that were prescribed to her for paroxetine, aprazolam, benzodiazapine, Xanax, Adderall, and others, in addition, she was using her grandmother’s oxycodin. Even one of these drugs alone may cause insanity, and per her comments, it doesn’t seem like she actually remembered what she did, at least she didn’t know why. for examples of other manufactured lunatics, there is Kevin Underwood, who, on taking Lexapro killed a neighbor girl with the intention of eating her, Alyssa Bustamante, a 15 year old girl who killed her 9 year old neighbor after being on Prozac for 2 years, the VA Tech shooter withdrawing from antidepressants, and the Columbine shooters on court ordered antidepressants. Doctors see you for about 15 minutes before prescribing these mind altering drugs, they operate like people who have had numerous and substanital head injuries. But it is unknown whether these were all prescribed to Melissa legitimately or if she went around to numerous doctors not telling them about the other drugs. (Like Michael Jackson.)

  6. […] Finally, the authors find that Part D has no effect on health in terms of either functional status or self-reported health.  [The authors measure functional status as the number of ADLs and IADLs.] In fact, the authors note the following: “If anything, estimates suggested that gaining prescription drug insurance was associated with worsening health.” Could this be because some physicians overprescribe drugs which could actually worsen outcomes?  Is functional status and self-reported health sufficiently precise to capture the benefit of these drugs?  Are the benefits of pharmaceuticals generally confined to short-run benefits? […]

  7. […] Finally, the authors find that Part D has no effect on health in terms of either functional status or self-reported health.  [The authors measure functional status as the number of ADLs and IADLs.] In fact, the authors note the following: “If anything, estimates suggested that gaining prescription drug insurance was associated with worsening health.” Could this be because some physicians overprescribe drugs which could actually worsen outcomes?  Is functional status and self-reported health sufficiently precise to capture the benefit of these drugs?  Are the benefits of pharmaceuticals generally confined to short-run benefits? […]

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