Do You Have Depression? Here's a New Risk

The discovery that many people with life problems or occasional bad moods would willingly dose themselves with antidepressants sailed pharma through the 2000s. A good chunk of pharma's $4.5 billion direct-to-consumer advertising has been devoted to convincing people they don't have problems with their job, the economy and their family, they have depression. Especially because depression can't be diagnosed from a blood test.

Unfortunately, three things dried up the depression gravy train for pharma. Blockbusters went off patent and generics took off, antidepressants were linked with gory and unpredictable violence, especially in young users, and they didn't even work, according to medical articles.

That's when pharma began debuting the concept of "treatment resistant depression." It wasn't that their drugs didn't work (or you didn't have depression in the first place), you had "treatment resistant depression." Your first expensive and dangerous drug needed to be coupled with more expensive and dangerous drugs because monotherapy, one drug alone, wasn't doing the trick.

You've got to admire pharma's audacity with this upsell strategy. Adding drugs to your treatment resistant depression triples its take, patients don't know which drug is working so they'll take all of them and the defective drugs are exonerated (because the problem is you).

Now pharma has a new whisper campaign to keep the antidepressant boat afloat. Your depression is "progressive." Once upon a time, when depression was neither seasonal, atypical, bipolar or treatment resistant, it was considered to be a self-limiting disease. In fact, just about the only good thing you could say about depression was it wouldn't last forever.

But now, pharma is giving depression the don't-wait scare treatment like coronary events (statins), asthma attacks ("controller" drugs) and thinning bones (Sally Field). If you don't hurry and take medication, your depression will get worse!

"Depressive episodes become more easily triggered over time," floats an article on the physician website Medscape (flanked by ads for the antidepressant Pristiq). "As the number of major depressive episodes increase, the risk for subsequent episodes is predicted more from the number of prior episodes and less from the occurrence of a recent life stress." The article, unabashedly titled "Neurobiology of Depression: Major Depressive Disorder as a Progressive Illness," is written by Vladimir Maletic, who happens to have served on Eli Lilly's Speaker's Bureau, says the disclosure information, and whose co-authors are each employees and/or Lilly shareholders.

Before direct-to-consumer advertising, the health care system was devoted to preventing over-treatment and assuring patients they were probably okay. Who remembers, "Take two aspirin and call me in the morning"? Now patients are assured they probably aren't okay but probably have a progressive disease. Luckily, their disease can be treated with progressive prescriptions from pharma.

 

 

 

Comments

[Ellen Cross]

10:46 AM on 08/29/2011

Medication is a valid form of treatment - where needed. Not all need it, but blanket prescribing rather than considering other forms of treatment is culprit. Childhood neglect and abuse resulting in emotional difficulties can't always be fixed by eating right and jogging.

[danceswithdata]

06:43 PM on 08/14/2011

I agree wholeheartedly with this author. But it just isn't depression that is getting special treatment by Big Pharm and the insurance companies. If that were true at least we would have the epidemic isolated. It's anything to make a buck. How often did you hear about Sleep Apnea 10 to 12 yrs ago? Never is the correct answer. Now, it is the trendiest disease out there, the illness-du-jour, and everyone has it. I have been diagnosed with a "mild" case of it. A couple of different doctors tried to make me sleep with one of those awful torture-chamber style masks attached to straps that is similar to wearing a helmet to bed. Did it work? Nope. But are the doctors and the insurers cleaning house on this latest "malady"? You bet. They tell you that you can suffocate in your sleep if you don't wear one of their contraptions. I tried going online to find statistics of the number of deaths per thousand from Sleep-Apnea-Suffocation there are documented, but of course such stats are non-existent. We are in dire need of returning to the times when wellness was the main focus of good health care, and as many treatments as we can use before we must resort to Rx drugs should all be tried FIRST!! The end of my Sleep Apnea treatment? I had to sign an AMA form at the Oxygen store! "Against Medical Advice" the ultimate in ass-covering documentation.

[jstrate]

05:06 PM on 08/14/2011

Perhaps the executives of pharmaceutical companies should be automatically enrolled in drug trials testing the side effects of the anti-depressant drugs for which their companies are seeking FDA approval. I'm sure they would be delighted to make this small contribution to the advancement of medical science.

[danceswithdata]

06:46 PM on 08/14/2011

Fantastic idea, jstrate. And one I'm sure they would all participate in with unbridled enthusiasm!

[aaronrossi]

11:44 AM on 08/14/2011

i am a pharmacist and i have ALWAYS been against anti-depressants. they are complete BS for about 95% of patients that take them. you cannot trust anyone these days, not corporations, not the fda, not your doctor, and not even your pharmacist.

[Linda P]

11:30 AM on 08/16/2011

What is your professional opinion about the following list of prescribed medications?
Citalopram HBR 40 mg Tablet
Tramadol HCL 50 mg Tablet 400 mg/day
Hydrochlorothiazide 12.5 mg (did not have high blood pressure before taking these medications)
Gabapentin 300 mg - 900 mg 3x/day (2700 mg/day)
Mirtazapine 45 mg tablet
Respiradone .5 mg/day
Baclofen 20 mg tablet 80 mg/day
Alieve (over the counter average 3x/day)
Alprazolam 1 mg tablet as needed to stop seizures (did not have seizures before taking these medications)

(Patient was prescribed various other medications which were discontinued ... this is the latest combination... )

[Ty Thompson]

05:48 PM on 08/13/2011

This came about nearly the same time as the denial of any regrets did. This lead to anyone with a regret accused of ruminating and having a problem. This attitude lead to people repeating the same mistakes, remaining unhappy and instead of changing perceptions or behavior, blamed it on a medical condition and took happy pills. Said people continued with their delusional lifestyle, making other people miserable in the process. The twisted logic became mainstream, sociopathy and narcissism became celebrated qualities, those that didn't like it had the problem and needed medication.
rinse, lather repeat.

[Bellanova]

05:23 PM on 08/13/2011

The Medscape Psychiatry bulletins are a convenient way for PhRMA to push its wares and ideology. It appears that the majority of authors of the articles included there, especially those under the "new research" rubric, are in some way associated with pharmaceutical companies. The fine print with disclosures (thank goodness for it) is dismayingly revealing.

[tempist771]

04:28 PM on 08/13/2011

I don't see why both alternative , and conventional medicine cannot be used, as they both have their strengths. Conventional medicine in the US is very bad at preventing disease, and it can be overly invasive, and not deal with the underlying problems. However, if I had shirked it when I had a rapidly growing tumor in my lung I would not be around to post this right now.

Big pharma does have a lot of influence on medical practice,and it is important to go in with your eyes open. They do also suppress effective "natural" treatments, but this does not mean all conventional medicine=bad and all alternative medicine=good. Diabetes can be very effectively controlled by diet , but that does not mean that you should not use insulin for an acute problem if you need it.

[Linda P]

11:11 AM on 08/13/2011

we sont' know for a month or so if the damage caused is permanent... so if you have been subjected to polypharmacy and are having strange problems since, look up Adverse side effects, Tardive Dystonia/Dyskenesia, Akasthesia, and Serotonin Syndrome, begin to wean off your meds slowly and find a different doctor who will look at your medication list and be honest with you, ... and good luck to you ... as these medication combinations WILL make you look and act "crazy"

[jack Winn]

08:47 AM on 08/20/2011

Honesty depends on knowledge, and there isn't much of that in this area.

[Linda P]

11:11 AM on 08/13/2011

What they are promoting is called Polypharmacy.... please use a medication checker program to find drug - drug interactions, for example if you are taking Tramadol and Citalopram, you are at risk for a severe drug adverse event as the antidepressant renders the Tramadol ineffective and can cause really bad side effects... Polypharmacy is rampant in depressive disorders... even if you don't have depression you may be diagnosed with it, over medicated with a couple of antidepressants, mood stabilizers, and muscle relaxors and anticonvulsants, a benzodiazine, and then need meds for hypertension as these will raise your blood pressure .. after being on 7 medications including one to control the almost daily seizure activity, Parkonsonian like tremors, altered mental status, stuttering, tonic-clonic movement disorders CAUSED BY this polypharmacy cocktail and which the PCP refused to recognize, the mental health providers refused to recognize, the ER refused to recognize, even after nearly daily life threatening seizure activity ... and when they happened in the PCP's office, and the mental health provider's office ..please use a prescription checker program because it may save your life... we are off all the meds against the advice of these doctors, have not had a seizure now for nearly 2 weeks, other adverse movement disorders have reduced greatly tho not gone, and our new PCP told us some of these movement disorders may be permanent due to these medications and the damage they have caused

[BetNot]

10:36 AM on 08/13/2011

I don't know how progressive it is, but it is chronic and life long, for some people. The cartoon is right, and the worst part is the doses they give to patients in care facilities, hospitals etc. when it is not indicated. That is a crime, but it is really a symptom of letting them give a pill for every ill, whether it actually works or not...

[OverseasVet]

09:27 AM on 08/13/2011

Using the big pharma strawman is a poor logical argument. Its as bad as the "toxins" gambit of the suppliment salesmen. Take vitamin C or Zinc or put needles in your body. Personally I choose medical science.

[jstrate]

09:15 PM on 08/13/2011

Not a pharmacist but I've taken time to read through clinical trials (with strong knowledge of methods and statistics) and generally am not impressed with the sample sizes used, the duration of the trials, or the magnitude of the effects reported. Anti-depressants and anti-psychotics work differently on different patients. Many of the latter have horrible and dangerous side effects and patients often stop taking them. Nutrition and exercise (if possible for a patient) should be a first option, not a last.

[jack Winn]

09:51 PM on 08/13/2011

Medicine has objective indicators, and distinguishes itself from psychiatry, which is an attempt at methodical description of behavior patterns, and does not include any objective indicators.

When you try to conduct research in terms of unquantifiable, unmeasurable DSM diagnoses, you will get whatever results your boss wants.

Look at any psychiatric study, and look at every diagnosis it cites, and check that diagnosis in the DSM, and ask how it can be distinguished from anything else. I've heard this discussion in national conventions, and the answer is to the effect, "we know it when we see it". Yet they still can't describe it, and they can't get any better than random results.

Take a look at the Wikipedia article on the Rosenhan experiment showing conclusively that psychiatric practitioners could not recognize a diagnosis, and that experiments within the last 3 years have confirmed nothing has changed.

These are behavioral issues, and neither medicine nor philosophy gets any better results than traditional witch doctors.

[tweeksmom]

07:36 AM on 08/13/2011

That cartoon is funny! And spot on!

[Gadgetman]

03:57 AM on 08/13/2011

"progressive depression"? It's more like progressive big pharma profits.

[Bellanova]

05:24 PM on 08/13/2011

They go hand in hand.

[jack Winn]

09:54 PM on 08/13/2011

Of course people get sad when they don't see progress, especially in their heads.

With all due respect to the experience of fellows like Dick Cavett, dwelling on the issue is rarely effective, nor are pills. OTOH, getting on a bike & going for a ride, working in the garden, tickling somebody, doing ALMOST ANYTHING gets wondrous results.

[Chockolate]

11:10 PM on 08/12/2011

I battled high blood pressure for years, and they had me on all sorts of pills to keep it down.

Then I gave up coffee and it magically dropped down to normal. What a rort.

[assumetheopposite]

02:57 PM on 08/19/2011

Sweetie, caffeine is poison. Besides HTN, it causes heart disease, stroke, breast cancer, prostate cancer, diabetes II, osteoporosis, PMS, hot flashes, seasonal allergies and world hunger/extreme poverty. Caffeine crops won't grow in four season climates, so millions of tropical peasants are condemned to starvation because the World Bank, IMF, and WTO force them to grow drug crops for the Western caffeine addiction instead of FOOD that sustains LIFE. Doctors and their camp followers (PhRMA, medical device makers, etc.) receive beaucoups of bribes from Big Caffeine to cover up the hazards of the beverage industry and make fraudulent health claims about it, just as they had with Big Tobacco for nearly a century.

[Wolf Klauschie]

11:09 PM on 08/12/2011

My antidepressants do not make me feel good, but when I don't take them I have an history of trying to kill myself. After two failed attempts while not taking them, I think it is reasonable for me to keep taking them.

[OverseasVet]

09:33 AM on 08/13/2011

Don't fall for the big pharma strawman argument that the alt med groups use to try to get you off medicine. Stay on your meds and be well. And god bless.

[danceswithdata]

06:54 PM on 08/14/2011

So do I, Wolf. These drugs do have a place, I do not believe that anyone is foolish enough to say that they do not, or that they should be banned, or anything like that. I think what we are getting at is how overly used they are in many instances where it is so unnecessary. And most of that over use comes from pressure from Big Pharm and the doctors and insurers who are making huge bucks on these things.