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Rethinking Depression and Anxiety Treatment Methods: The Risk of Overprescribing

Introduction

This article is all about depression and anxiety. Particularly our most recent understanding of causes and treatment methods. In this article you will learn about the overwhelming increase of people in the United States being diagnosed with depression and anxiety. You will learn about the risks associated with certain medications used to treat these disorders. You will learn about new research on the causes of depression. You will learn why medication to treat depression and anxiety is not as beneficial as once believed.


Please understand it is not my intention to diminish or invalidate people with depression and/or anxiety who have benefited from pharmaceutical treatment and wish to stay on their medications. It is my goal to offer new insight based on science and evidence that empowers people to choose what is right for them.


Please be aware I am not a licensed clinician or psychiatrist. None of what you read should be taken as advice. If after reading this article and checking out the resources I provide, you decide you no longer want to take antidepressants or antianxiety medication please understand withdrawal symptoms are real and severe for some people. Therefore, never stop a medication cold turkey. Instead talk with your doctor and find a tapering solution that works for you.


Prevalence of Depression and Anxiety Disorders

In the United States there has been a significant increase in the numbers of adults and children diagnosed with depression and/or anxiety disorders. There is also a skyrocketing increase of people being prescribed antidepressants like Selective Serotonin Reuptake Inhibiters (SSRIs) and Benzodiazepines. Current statistics by National Institute of Mental Health state that 8.4 percent of all US adults have been diagnosed with Major Depression (Major depression, 2022). Percentage is highest among young adults 18 to 25 years old, females, and persons of mixed race/ethnicities (Major depression, 2022). These are 17, 10.5, and 15.9 percent respectively (Major depression, 2022). Additionally, nearly 1/3 of Americans have suffered from an anxiety disorder at least once in their life (Any anxiety disorder).


Why are we seeing such an exponential increase? There really is not one reason more Americans are depressed and anxious now than ever before. A few possibilities for the increased prevalence in depression and anxiety disorders include living a more stressful life, fear surrounding Covid-19, isolation brought on by the pandemic, lack of socializing in person due to social media, and decreased stigma allowing more people to feel comfortable seeking support.


Depression Treatment and New Research

An astounding number of individuals reported taking antidepressants. In 2020, more US Americans were prescribed antidepressants compared to previous years. Specifically, the percentage of antidepressants prescribed rose to 18.6% (Kelley, 2020). An article published in 2017 on CBS News reports “Antidepressant use in U.S. soars by 65 percent in 15 years.” (Mundell, 2017). In 2014, 1 in 8 Americans aged 12 and older reported taking antidepressants (Mundell, 2017). The use of these medications continues to escalate. As stated by (NHS DATA, 2022), there has been a 41% increase in children ages 5 to 12 being prescribed antidepressants between 2015 and 2021!


Twenty years ago, research showed antidepressant effectiveness at 70% compared to placebo being 30% (Khan & Brown, 2015). That statement has since been proven false. The reality is antidepressants alleviate depressive symptoms only 40% compared to placebo at 30% (Khan & Brown, 2015). In fact, new research shows that depression is not solely caused by a chemical imbalance or low serotonin levels in the brain. Instead, many factors are at play in addition to the chemicals in our brain, including stressful live events, circumstances, environment, and thinking patterns. For example, the more times a person experiences long term stressful episodes the greater their chance is of developing depression. Surrounding oneself with negativity or becoming socially isolated can also make a person more susceptible to symptoms of depression. There are many lifestyle factors within our control that can exacerbate depressive symptoms, help mitigate them, and protect against them. Things like spending time in nature, listening to uplifting music, exercising, reframing negative thinking patterns, and simply taking care of one’s own needs can help people who have depression. Engaging in these activities may also help alleviate symptoms of anxiety.


It is important to be aware of these and understand the chemistry of depression. According to Huberman (2021), people with low levels of serotonin may experience feelings of guilt and shame. People with low dopamine levels may experience loss of motivation and anhedonia which is defined as loss of pleasure in activities previously enjoyed. People with low norepinephrine may experience fatigue. Knowing these facts can help people without depression understand why it might be difficult for someone with depression to socialize with others, stay active, and think positively about themselves. However, these are not impossible tasks!


Anxiety Treatment and New Research

There has also been an increase in the prescription of anti-anxiety medications. In 2020, anti-anxiety prescriptions increased by 34.1 percent (Kelley, 2020). It is not clear which specific anti-anxiety medications they are referring to. Common types of prescription medication used to treat anxiety disorders include SSRIs and Benzodiazepines. As stated by (Sarangi et al., 2021) “A study done by Bachhuber et al. showed that the number of adults who filled a benzodiazepine prescription increased by 67%, from 8.1 million to 13.5 million between the years 1996 and 2013. The quantity obtained also increased from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults.” A few well-known benzodiazepines include Klonopin, Xanax, and Ativan. As stated by (Sleeping Pills and Minor Tranquillisers), the latter two are classified as short acting drugs meaning they are processed quickly and exit the body faster than long-acting drugs.


Withdrawing from these short acting benzodiazepines is extremely difficult due to the body having insufficient time to cope without them (Sleeping Pills and Minor Tranquillisers). The addictive nature of benzodiazepines leads them to being misused and abused. Between 2015 and 2016, 30.6 million (12.6%) adults reported taking benzodiazepines, and 2.2% of these people misused them (Sarangi et al., 2021). Yet, the evidence supporting the effectiveness of benzodiazepines compared to placebo is lacking in quality (Breilmann et al., 2019).


Although the topic of anxiety and SSRIs compared to placebo has not been studied as extensively as treating depression with SSRIs, new research indicates that at least one SSRI does not significantly improve symptoms of anxiety when compared to placebo. Researchers at Wayne State University and Harvard School of Medicine studied the effectiveness of paroxetine (Paxil) for treating anxiety disorders. An article by Sugarman (2019) says the researchers reviewed 12 clinical trials, sponsored by the drug’s manufacturer GlaxoSmithKline (GSK), comparing the benefit that people with Generalized Anxiety and Panic Disorder experienced when taking paroxetine (Paxil) compared to a placebo sugar pill. They measured improvement by using the 56-point Hamilton Rating Scale for Anxiety. Before treatment the average scores ranged between 19 to 26 points. On average, participants who received paroxetine (Paxil) experienced improvement by 11.1 points while those taking a sugar pill improved by 8.8 points. A difference of only 2.3 points is incredibly small and the effectiveness of paroxetine (Paxil) should be further questioned.


One of the saddest parts of all this is paroxetine (Paxil) along with other SSRIs often come with unwanted side effects that are sometimes worse than the initial symptoms a person is trying to treat. These side effects include drowsiness, insomnia, weight-gain, sexual dysfunction, increased suicidal thoughts in children and adolescents, and serotonin syndrome which is an adverse life-threatening reaction to the medication (Sugarman, 2019). It is also difficult to withdraw from these medications due to relapse of symptoms. Therefore, it is common that people continue these medications for years and sometimes decades.


Conclusion

Pushing the medical model of depression and anxiety and stating it is just because of how a person’s brain is wired may disempower people and make it feel absolute. Calling depression and anxiety terminal and over prescribing antidepressants and benzodiazepines is not improving peoples lives. If it was, we would see a much better overall effectiveness and lessening of symptoms after taking these prescriptions. What if instead we taught people about how the brain works and what is in their control. We focus on their strengths and exceptions to their challenges. We listen and offer comforting support. We tell them their struggles do not have to last forever.


Citations


Breilmann, J., Girlanda, F., Guaiana, G., Barbui, C., Cipriani, A., Castellazzi, M., Bighelli, I., Davies, S. J., Furukawa, T. A., & Koesters, M. (2019). Benzodiazepines versus placebo for panic disorder in adults. The Cochrane database of systematic reviews, 3(3), CD010677. https://doi.org/10.1002/14651858.CD010677.pub2

Huberman , A. (2021, August 23). Understanding & Conquering Depression | Huberman Lab Podcast #34. YouTube. Retrieved January 13, 2023, from https://www.youtube.com/watch?v=Xu1FMCxoEFc&t=112s

Kelley, A. (2020, April 16). Americans are taking more anti-anxiety medication and antidepressants during coronavirus pandemic: Report. The Hill. Retrieved January 13, 2023, from https://thehill.com/changing-america/well-being/mental-health/493125-increase-in-anti-anxiety-medication-antidepressants/

Khan, A., & Brown, W. A. (2015, October). Antidepressants versus placebo in major depression: An overview. World psychiatry : official journal of the World Psychiatric Association (WPA). Retrieved January 13, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/

Mundell, E. J. (2017, August 16). Antidepressant use in U.S. soars by 65 percent in 15 years. CBS News. Retrieved January 13, 2023, from https://www.cbsnews.com/news/antidepressant-use-soars-65-percent-in-15-years/

NHS DATA: 41% rise in antidepressant prescribing to children aged 5-12 since 2015. Mad In America. (2022, May 28). Retrieved January 13, 2023, from https://www.madinamerica.com/2022/05/nhs-data-41-rise-antidepressant-prescribing-children-aged-5-12-since-2015/

Sarangi, A., McMahon, T., & Gude, J. (2021, June 21). Benzodiazepine misuse: An epidemic within a pandemic. Cureus. Retrieved January 13, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294026/

Sarangi, A., McMahon, T., & Gude, J. (2021, June 21). Benzodiazepine misuse: An epidemic within a pandemic. Cureus. Retrieved January 13, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294026/

Sleeping Pills and Minor Tranquillisers. Mind. (n.d.). Retrieved January 13, 2023, from https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/comparing-benzodiazepines/

Sugarman, M. A. (2019, September 12). Are you taking ssris? antidepressants for anxiety. Anxiety.org. Retrieved March 2, 2023, from https://www.anxiety.org/how-effective-are-antidepressants-treating-anxiety

U.S. Department of Health and Human Services. (2022). Major depression. National Institute of Mental Health. Retrieved January 13, 2023, from https://www.nimh.nih.gov/health/statistics/major-depression

U.S. Department of Health and Human Services. (n.d.). Any anxiety disorder. National Institute of Mental Health. Retrieved January 13, 2023, from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder#part_2576



Video Recommendations


The Myth of Low-Serotonin and Antidepressants- Dr. Mark Horowitz



This is the number one video I would recommend people watch if they are interested in this topic.


To better understand depression, I recommend watching or listening to the podcast by Dr. Andrew Huberman titled Understanding and Conquering Depression




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