Too stoic for antidepressants

Should people who are depressed take antidepressant medication, or should they just tough it out?

There’s often a stigma surrounding the use of antidepressants, and it may be preventing people from getting the treatment they need, college student Leah Lancaster wrote this week in an insightful opinion piece for the Minnesota Daily.

Lancaster writes that she has been taking antidepressants since she was 15 years old – and that without them, she most likely would not have gone to college. “Yet, when the topic comes up, I often find myself defending my decision against accusations that I’m ‘numbing myself’ or ‘taking the easy way out,’” she writes. “Supposedly, if I did yoga, ate healthier and took a more ‘natural’ approach, I wouldn’t need to contaminate my mind and body with toxic pills.”

Some of the stigma surrounding depression itself seems to have eased in the last couple of decades. But when it comes to antidepressants, it can still be hard for the public to accept that for many people, medication may be necessary to help them feel better.

It’s hard to measure how widespread this attitude might be. It clearly exists, however, and one of the consequences is untreated depression. A study that appeared last year in the Annals of Family Medicine found that patients often don’t tell their primary care doctor that they’re experiencing depression. The No. 1 reason for this lack of disclosure? They feared being prescribed an antidepressant.

Even in the medical setting, patients often are reluctant to report that they take prescription medication for depression or anxiety, writes Mag Inzire, a physician assistant at a community hospital in New York.

The patients she encounters rarely worry about disclosing a history of diabetes or high blood pressure, she wrote. “Yet when it comes to depression or anxiety, there is some uncertainty in their response. And it always seems to follow by some long, drawn-out explanation as if to justify the diagnosis.”

Depression in fact is relatively common. In any given year, about 6.5 percent of the
American population will experience depression. Across a lifetime, about 16.2 percent of the population will have depression at some point. Stigma or not, antidepressants are one of the most frequently prescribed drug categories in the United States.

How antidepressants work in the brain, and whether they’re truly effective, is a matter for some debate. At one time it was thought that low levels of serotonin, a mood-enhancing chemical, were a trigger for depression, and that drugs such as Prozac, which raise the level of serotonin in the brain, would correct this. This theory has been called into question, though, and if continuing neuroscience study is any indication, the role of antidepressants is considerably more complex than this.

Why, for instance, does medication seem to be more effective for severe depression but less so for mild or moderate depression? Why do some antidepressant medications cause a worsening of depression in some people?

Studies have found that people with mild depression often do well with talk therapy alone. Other studies have found that a combination of medication and talk therapy is often most effective for mild to moderate depression. What does this mean for the role of talk therapy in treating some forms of depression?

Of the millions of antidepressant pills dispensed in the U.S. each year, some likely have been overprescribed to those who don’t really need them. “The reality is that many psychiatrists do give out pills too freely, and many patients start taking medications without properly researching them beforehand,” Lancaster writes.

But in her own case, antidepressant medication has made the difference between being able to function vs. withdrawing from life, she wrote.

Medication hasn’t been a cure for her. “No pills can do that,” she wrote. “What they can do is give you some energy and focus so you can make it through the day without feeling lethargic, irritable or just downright horrible.”

And she notes a double standard, at least in college-campus culture, of peers who view binge drinking, smoking, unprotected sex and “study drugs” as socially acceptable but believe antidepressants are “dangerous and mind numbing.”

“Like any medicine, antidepressants aren’t perfect,” she wrote. “But to make the sweeping generalization that all of them are bad is dangerous and prevents many from getting the help they need.”

Will the mental health stigma ever end?

My calendar today says it’s Aug. 8, 2012. That’s more than a decade into the 21st century. So why does it still often feel we’re back in the Dark Ages when it comes to mental health?

The latest evidence that the stigma surrounding depression and substance use remains alive and well was demonstrated this week in the petty politicking of Sen. Mike Parry of Waseca, Minn., who portrayed Minnesota Gov. Mark Dayton as a pill popper and “scary.”

You can say this for the critics: They were immediately all over Parry like glue on a cheap campaign bumper sticker. Maybe there’s more enlightenment out there than I think.

But would that this were about politics alone.

I don’t know Sen. Parry, I wasn’t at the Brown County Republican fundraiser where the remarks were made, and I wouldn’t presume to guess what he was thinking. But given that Gov. Dayton has been open about his depression and alcoholism, both of which have been treated, it’s hard to see this as anything other than a barb aimed squarely at the “weakness” implied by taking medication for a mental health issue.

And it’s shameful, because the last thing we need is to perpetuate the negative attitudes and judgments that often make it so hard for people to get help.

I had the opportunity last week to visit with some folks at Chippewa County Montevideo Hospital and Medical Clinics, here in west central Minnesota, about a community survey they’re launching this month to learn more about local attitudes regarding mental health and substance use.

The health providers in Montevideo have been working hard in the past few years to get better at identifying people who may have issues with depression and unhealthy substance use and connecting them with sources of help. What they’ve discovered, however, is that it’s often difficult to even begin the conversation. Patients are uncomfortable talking about it; sometimes doctors are uncomfortable too.

It’s hoped that the survey will give Montevideo health providers a better understanding of how their community feels about depression and substance abuse and lead to some strategies that will help.

People don’t get better when these issues stay in the closet. But to admit to being depressed, or to having a problem with alcohol, is to risk opening up oneself to negative judgments by the misinformed. The fact that a public figure would even go there – and on the record, no less – makes it painfully clear that the fear of being stigmatized is well founded.

Consider a poll conducted in 2004 in Tarrant County and Fort Worth, Texas, that found two out of five of those surveyed believed anyone with a history of mental illness should be barred from public office, more than 40 percent believed major depression was the result of a lack of willpower, and fully 60 percent thought “pulling yourself together” was an effective treatment for depression. Or a 2009 study in the Medical Care journal that concluded fear of stigma and how their parents would react was a major reason why adolescents didn’t seek treatment for depression. Or recent research suggesting that one in three U.S. soldiers with post-traumatic stress syndrome doesn’t seek treatment because of the stigma.

Really, the Parry incident shouldn’t be worth the ink being spent on it, except for one thing: the message that is sent by looking the other way.

Untreated depression and substance abuse take a toll on people’s lives, on their quality of life and their human potential. They take a toll on society. The consequences are serious indeed: Of the thousands of Americans who die by suicide each year, the vast majority have an untreated or ineffectively treated mental illness, most commonly depression.

Can we afford to allow the misinformation and stigma to continue? I don’t think so. Please get the facts and get educated. If you can’t or won’t, then at least have the grace to just keep quiet.