However you ask the question, you always get the same answer. More antidepressants than any other medication have been prescribed to Americans over the last twenty years. This is a remarkable statistic when you think of all the possible illnesses and diseases that physicians could be treating. According to the preliminary data for mortality in 2005 complied by the Centers for Disease Control and Prevention, the top three causes of death were:
• heart disease 21.9%
• cancer 18.9%
• stroke 4.8%
Yet, even when you go to the top fifteen listed causes, no-one dies of being depressed (although suicide is the 11th most common way of dying). So what are these prescriptions for? The most prescribed antidepressant medication in the US is Zoloft with more than 28m prescriptions written in 2006. Zoloft is one of the Selective Serotonin Reuptake Inhibitors (SSRIs). It is designed to change the level of serotonin, one of the neurotransmitters in the brain. Serotonin helps to regulate your mood. That means that a vast proportion of the pharmaceutical industry’s profit comes from convincing people who are not likely to die soon that they need to buy antidepressants like Zoloft, so they can feel better. Teach them to feel dysfunctional and depend on medications for the rest of their lives.
But, of course, this is just to provoke you into thought. In his article in The New England Journal of Medicine (2006), Friedman invoked the National Comorbidity Survey as evidence that fifty percent of all serious adult psychiatric illnesses, including substance abuse, anxiety disorders and major depression, have started by the age of fourteen years, and three quarter are in place by twenty-five years. He confirms suicide as the third-leading cause of death among persons fifteen to nineteen years of age.
Thus, if we were to classify suicide as a psychiatric illness, we would get a different perspective on national mortality rates. Now, let us step back from mortality data to a better measure. Mental illnesses are increasingly relevant to the mission of disease prevention and health promotion. Chapman and Perry in their article at Prev Chronic Dis (2008) warn that, by 2020, depression will be second only to heart disease if you measure using disability-adjusted life years.
So, if you accept the reality of psychiatric illness as a disability, the need for treatment becomes obvious. Now look at the people with heart conditions or cancer. If they are also depressed, this robs them of whatever quality of life they might otherwise have enjoyed, and probably reduces their life expectancy by undermining their will to live. Morally, the state should ensure that its citizens are given the best treatment possible. Economically, the state faces an increasing burden of social security payments with a declining tax revenue. States should therefore ensure preventative and therapeutic care is available to all.
So, when you put anxiety disorders and depressive illnesses into a proper context, the need for medications such as Zoloft becomes obvious. And why is Zoloft the most prescribed of all the antidepressants? Because, the physicians who write the millions of prescriptions watch over their patients. If the medical professionals and their patients did not see a safe and effective product, the free market economy would operate and people would switch to another medication. That has not happened. Zoloft remains the trusted response to depressive illness.
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