1 in 10 Take an Antidepressant

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About 10% of Americans took an antidepressant drug in 2005, a new study finds. That's up from about 6% in 1996. But only about one-quarter of the people who took the drugs were being treated for depression. That ratio hardly budged during the period studied. This means that most people are using the medicines for other conditions, such as anxiety. The study used data from U.S. government surveys. They included only people over age 6. Researchers also found that only one-fifth of those who took an antidepressant were receiving psychotherapy. That's down from nearly one-third in the earlier survey. Blacks and Hispanics were only about half as likely as other Americans to take antidepressants. The study appeared August 3 in the journal Archives of General Psychiatry.

What Is the Doctor's Reaction?

About 10% of Americans over the age of 6 take an antidepressant. That's 27 million Americans. It's also double the number from 10 years ago. Now, antidepressants are the most widely prescribed class of medicines in the United States.

My patients who take these drugs have a hard time giving them up. One time I suggested stopping Zoloft for a patient who seemed recovered from her depression.

She surprised me by saying, "No, please don't stop my prescription. And don't tell. I have been putting it into my husband's cereal every morning, and it works well!"

In the same time that we doubled antidepressant use, fewer Americans sought out psychotherapy. In 1996, almost one- third of people who had depression had psychotherapy. In 2005, about one-fifth did.

What does this mean about Americans? For sure it shows that we prefer pills to other treatments. But do we suffer from more depression now than we used to? Perhaps, but that can only account for a small part of the increase in antidepressant use.

No, the more honest reason that we use so many of these drugs is that we don't fear them. Doctors prescribe them (and patients use them) casually. That's because modern antidepressant medicines have a reputation of being safe.

Are they safe? I need to answer this question quite carefully. Untreated depression is itself not safe. In general, antidepressants that are available today are very safe. But no drug is perfect. I believe we use antidepressants too often and (for many patients) for too long.

Here are my top three concerns:

1. Suicide risk -- Antidepressant use might increase the risk of suicide. In both children and adults, suicides have occurred within days or weeks after they were prescribed an antidepressant or the dose was increased. This also occurred in studies of two antidepressants given to children. Children who received the drug had more suicide risk at the start of treatment than those who took a placebo. This topic is still being studied.

2. Bone thinning -- Two studies have found a link between selective serotonin reuptake inhibitors (SSRIs, such as Prozac) and reduced bone strength. Older women who take antidepressants have double the expected rate of bone density loss. Men who take SSRI drugs have lower average bone density than non-users.

3. Drug interactions -- Some antidepressants can interfere with how the body uses other drugs. They can raise the level of certain narcotics to toxic levels. In some cases they can increase the potential for harmful side effects from heart, blood pressure or seizure medicines. Most antidepressants act on the brain's serotonin system. So do some other drugs. These drugs can combine to cause severe symptoms known as the serotonin syndrome.

What Changes Can I Make Now?

Think carefully with your doctor about whether you need antidepressant treatment, and how long you will need it.

Make sure that you have been diagnosed correctly. Some people are receiving antidepressant medicine for mild symptoms. They may not need it. If you have depression, you should get checked for thyroid problems and anemia. Also, consider that you might have a sleep disorder. If substance abuse has caused your symptoms, antidepressant medicine is not the best way to manage your depression.

Consider non-drug treatments. Interpersonal psychotherapy is one option. It helps you to sort out which people in your life do and don't support you. It can help you to resolve stressful disputes and learn to take care of your own needs. Cognitive behavioral therapy teaches you to think positively, to solve problems and to rediscover simple pleasures.

Use antidepressants no longer than you need them. Experts agree that a person being treated for depression should continue prescribed medicine for at least six months. Major depression is a temporary illness. If you have serious depression symptoms or if you have planned suicide in the past, then much longer drug treatment may be appropriate.

Take care of your bones. Build up your bones with weight-bearing exercise, calcium and vitamin D. Avoid smoking.

Make sure someone monitors you closely for suicide thoughts when you begin an antidepressant or change doses. If you have severe depression, ask a friend or family member to ask you about suicide feelings at regular intervals. Schedule at least one follow-up visit with your primary care doctor or psychiatrist.

Never stop an antidepressant suddenly. Major withdrawal symptoms can occur. They include agitation, depression, headache and nausea.

Get regular exercise. Some small studies suggest that exercise may itself benefit depression. Exercise alone is not enough treatment for major depression. It should be an extra treatment and not a substitute for medicine or psychotherapy.

What Can I Expect Looking to the Future?

Are we truly finding better living through chemistry? Certainly some people are feeling happier. Doctors are identifying depression faster. People are more willing to discuss it. Quite frankly, we used to treat too few people who had depression. But one of our starkest measures of success in depression treatment has not changed very much. Despite the giant increase in prescriptions, we have had only a modest decrease in the U.S. suicide rate. In 1990, there were 12.4 suicides per 100,000 people. In 2004, the rate was 11.05 per 100,000 people.