Depressing: The Pharmaceutical Exploitation of Depression in America

Sawyer Batten ENG 303 14 April 2014

Enthymeme: Depression is being misdiagnosed to fit the masses and treated with pills which do not work for those masses, which started with the advent of Anti-Depressants in 1988 and pharmaceutical companies advocacy and campaigns since. Stasis Question: Consequence Major form of Appeal: Logos

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014

Depression is a condition affecting nearly ten percent of Americas adult population and one that will affect everyone at some point in their lives (Murray and Fortinberry). Because of this, it is important to look into the methods being used to treat depression and evaluate their effectiveness and benefits for patients. Currently, the most prevalent and ever-growing form of depression treatment is the use of prescription antidepressant drugs (Cohen). The use of these antidepressant drugs is not only proven to be ineffective on many patients, the drugs also have associations with many unpredictable negative side effects and are being prescribed, in increasing frequency, to patients that do not need prescription drug treatment for their symptoms. The following will explain what depression is, how depression characterization has altered and its diagnosis rate has skyrocketed within the last three decades, as well as the corresponding timeline of antidepressant drug development and their rise to becoming the mostprescribed drug in America. It will explain the advocacy of pharmaceutical companies that has resulted in people who are not depressed being told that they are, and people who do not have major or manic depression and do not have a chemical imbalance being given drugsdrugs with high dependency and suicide ratesthat cannot help them as an initial response to their mild depression instead of Talk therapies, which are proven to be more effective and harmless. Depression, as previously stated, is a very common mental illness that will somehow affect everyone at some point in their lives, whether as a victim or as a witness. Approximately 18.8 million Americans over the age of eighteen suffer from depression annually and nearly fifteen percent of all populations from developed countries worldwide suffer from depression 1

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 (Murray and Fortinberry). It is quite probable that most people have already personally experienced some form of depression or will at some point in the future. In order to tell, one must be aware of the symptoms of depression. Constant and unrelenting emotions of sadness, hopelessness, or worthlessness that result in a loss of interest in usual or enjoyable activities are the basic symptoms of depression (Ayers 15). Other indicators are fatigue and change in sleeping patters, loss of concentration and performance, change in eating habits, feelings of frustration, apathy, the development of compulsive behaviors, and violent thoughts of suicide or harming others (Ayers 16). The severity and duration of these symptoms determine the type of depression one is experiencing. There are three main types of depression: minor, major, and manic (also called bipolar disorder) (Psychotherapy to Treat Depression). Minor depression is characterized by depressive moods that persist and become like a lifestyle. Its symptoms are usually constant but not severe (Psychotherapy to Treat Depression). Major depression consists of three categories; reactive depression, endogenous depression, and psychotic depression. Reactive depression is caused as a response to a stressful or tragic event or loss. Endogenous depression is a form of depression that is hereditary or caused by a gene or chemical imbalance in the brain. Psychotic depression is a form of depression that usually results from stress or exhaustion and feeling overwhelmed (Ayer 11-12). Symptoms of major depression are usually more severe and intrusive that those of minor depression, and even though most cases of depression pass within a matter of months, it is still important to seek treatment. The final and most severe form of depression is manic depression or bipolar disorder. This form of depression is characterized by

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 dramatic mood swings from rage to depression that impair a persons ability to reason or control their emotions. This form of depression is the least common, but by far the most severe (Psychotherapy to Treat Depression). For all forms of depression, therapy is needed; the type of treatment, however, varies. The two most common types of treatment are Talk therapy and prescription drug therapy (Davis). These are often used together, but drug therapy has quickly become the most prevalent form of treatment which is, for the reasons I am about to share, unnatural, dangerous, and devised. Prescription drug therapy is the practice of prescribing prescription antidepressant drugs to patients. These drugs can alleviate symptoms of depression for some patients, but for a surprisingly large number of others they are ineffective or have many harmful side effects. Antidepressants are proven to benefit only about thirty percent of patients who take them (Martin and Fortinberry). This small percentage is generally composed of only the most severely depressed patients, as the majority of minor depression cases are treated just as well with placebos (Braun 121) Peter Breggin states that, Depression is obviously a psychological and spiritual condition; therefore, drugs do not do patients any good because they do not address the real problems or causes of depression (Braun 119). In a study done by the Lilly Pharmaceutical Company, makers of the antidepressant Prozac, results show that out of six tests, only once did Prozac have results better than those of placebos in patients (Braun 121). For some of the patients who did see improvement when taking antidepressants, once the medication stopped, their symptoms returned. A majority of antidepressant users experience a relapse after they stop their treatment, which creates drug 3

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 dependencies in many patients. This is due to the fact that antidepressant medications do not cure depression; they simply compensate for a malfunction in the body, in the cases when there is an actual malfunction (Franklin). In his book, The Science of Happiness, Stephen Braun states that, Today, millions of people have tried Prozac, Paxil, Serzone, or Wellbutrin and, after a period of experimentation, have dropped the drugs because they have found the experience unpleasant of unhelpful (159). When this happens, total relapse occurs and patients must start their drug treatment all over again (Ayer 53). Along with ineffectiveness are the prevalent harmful side effects that can create symptoms worse and more uncomfortable than those being treated initially. The side effects and severity of them are highly unpredictable. The effectiveness of the drug as well as the conditions it creates vary from person to person; the tolerance for dosage and length of use varies as well (Franklin) Common side effects are dry mouth, sleep disruption, weight gain, headache, nausea, urinary retention, gastrointestinal problems, abdominal pain, loss of libido, and agitation (Side Effects of Antidepressants). More serious side effects of the drugs are abnormal bleeding, the formation of brain tumors, suicide, and various sorts of violent acts (Murray and Fortinberry). In 2004, the drug Serzone was taken off the market after causing liver failure and twenty patient deaths (Prater). The varied response to these drugs is due largely to the fact that we do not yet fully understand the effects that the drugs have on the brain. Even pharmaceutical companies have stated that they do not fully understand how the drugs work (Side Effects of Antidepressants). Why, and how, really, are these drugs the go-to form of depression treatment in America?

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 In Britian, the use of any antidepressant on children, other than Prozac, is prohibited due to the fact that there is no scientific evidence proving that SSRIs work for any patient under 18 (Murray and Fortinberry). There is an established link between antidepressants and suicidal tendencies, which is magnified in young patients. All antidepressants available in the United States are proven to increase suicidal tendencies in patients under the age of twenty four (Prater). Ironically, preschoolers are the fastest growing market for antidepressant drugs. Four percent of American preschoolers have been diagnosed as clinically depressed and over a million of them are taking prescription drugs (Murray and Fortinberry). This indicates that prescription drugs are being over-prescribed and that this treatment method is being carelessly used. There is an interesting correlation between the increasing number of new depression patients needing prescription drugs and the profits of the pharmaceutical companies distributing these medications. Since the introduction of the first prescription antidepressant, Prozac, in 1988, the numbers of patients needing this drug have increased drastically and, by 2005, antidepressants were the most-prescribed drug in the United States with more than 118 million prescriptions. The use of antidepressants from 1995 to 2002 increased forty-eight percent (Cohen). Now, eighty percent of depression sufferers use antidepressants and only one quarter of those patients benefit (Davis). There is something wrong with that picture. We must ask ourselves why drugs are being prescribed so profuselycan it truly be the case that suddenly, corresponding with the advent of prescription antidepressants, that depression decided to ramp up its virulence to scourge status? Why are the drugs being prescribed en masse while, simultaneously, evidence of harmful effects and ineffectiveness mounts? Why did doctors

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 become more likely to write a prescription than first recommending a safer, more effective treatment? It is due to the massive profits being made by pharmaceutical companies, and thus, doctors, who distribute antidepressants. To illustrate this point, I will relate to you the 1985 case of the drug Protropin. Protropin was a revolutionary new drug for the treatment of Pituitary Dwarfism, however, there were only around 7,000 patients that actually suffered from that condition and that could benefit from the drug. This small patient pool could not return the profits needed to fund the development of the drug, so the drugs did not go on sale until the pool had been expanded to a size from which a profit could be made. So how did they increase the size of this pool? The company marketed the drug to children who fell under a certain height percentile, but who, in no way, suffered from Pituitary Dwarfism. By making shortness a diagnosable condition, the pool of 7,000 was expanded to 90,000 (Braun 113). It seems that much of the same is happening in the present antidepressant market. The difference between suffering from dwarfism and being short is a substantial one, yet a single pharmaceutical company decided to redefine the term dwarfism to include a condition that is not, and will never be, dwarfism. Similarly, pharmaceutical companies in America have campaigned, with much success, to define depression in a lax manner which maximizes their profits. Steven Braun states in, The Science of Happiness that, Drug companies try to block publications unfavorable to their interests. Many materials distort the reality of mental illness to broaden the pool of patients, unjustly tout the efficiency of the drug and promulgate outright falsehoods (111). Pharmaceutical companies like Lilly, Zeneca, Abbot, Pfizer, Glaxo, and 6

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 Wyeth-Ayerst have all sponsored and funded organizations which campaign and advertise that depression is caused by a chemical imbalance in the brain that can only be corrected by prescription drugs. While this may be fact in some cases, i.e. some degrees of major or manic depression that make up only thirty percent of users, Stephen Braun states in his book that, Depression is simply not caused by depleted Seratonin levels (126). Other researchers acknowledge that the chemical imbalance notion is outdated and used to sell more prescriptions (Prater). Currently Harvard Medical Schools website reads that, Its often said that depression results from a chemical imbalance, but that figure of speech doesnt capture how complex the disease is. Research suggests that depression doesnt spring from simply having too much or too little of certain brain chemicals, followed by Researchers understanding of the biology of depression is far from complete their understanding of the neurological underpinnings of mood is incomplete ( What Causes Depression). A Dr. Dworkin stated that, Doctors are now medicating unhappiness. Too many people take drugs when they need to be making changes in their lives (Cohen). As evidenced by the Protropin case, and also by the staggering statistic that only thirty percent of depression patients taking drugs are benefiting from themwhich means that seventy percent of users are notit is undeniable that American pharmaceutical companies have artificially expanded their patient pool by marketing a faux depression. These practices are aided by the allowance of pharmaceutical companies to perform their own testing on drugs to present to the FDA. An example of the way these get skewed involves a previously-mentioned Prozac study. Out of six tests performed, only one provided positive results. Only this test was presented to the FDA, however, with no record of the five failures, and

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 the drug became one of the top-selling prescriptions in the country. Had the FDA or some other third-party agency been in charge of testing, Prozac would likely have failed. The current liberty of pharmaceutical companies to do their own testing, free of oversight, is the equivalent of giving a student a take home test and a textbook. So why have this privilege? In his book, Stephen Braun acknowledges that the monumental profit to be made creates pressure on all aspects of development, testing, marketing and regulation. He discusses how the pressure can lead to false or misleading claims about a drugs safety, effectiveness, or unbalanced descriptions of the conditions the drug is intended to treat (136). With the following knowledgewhat depression is, how depression characterization has altered and its diagnosis rate has skyrocketed within the last three decades, as well as the corresponding timeline of antidepressant drug development and their rise to becoming the mostprescribed drug in Americaone cannot maintain that the advent of the drugs and resulting marketing by pharmaceutical companies has not manipulated the characterization and treatment of depression. People who are not depressed are being told that they are, and people who do not have major or manic depression and do not have a chemical imbalance are being given drugsdrugs with high dependency and suicide ratesthat cannot help them as an initial response to their mild (or non) depression instead of Talk therapies, which are proven to be more effective and harmless. This paper argues not to demonize anti-depressant drugs, but only to articulate that because of the substantial profiteering, power, and relationships between doctors and pharmaceuticals, that, like the Protropin case in which short peoplenot patients with dwarfismwere exploited and misled into receiving the drug, that depression has been

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 characterized in a way that makes everyone a candidate if they claim it. Further, doctors who make such (willfully) misinformed diagnoses should also know that for non-major or non-manic depression, for which Talk therapy should be the first step, yet they prescribe anti-depressants at a hats drop. Case studies, the evolution of how depression is characterized, and the synchronized rise of diagnosis rates and prescriptions prove that this practice is occurring in a most concrete way. This paper urges you to be aware, and if convinced, to share your new knowledge with a friend.

Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 Works Cited

Braun, Stephen. The Science of Happiness: Unlocking the Mysteries of Mood. New York: Wiley, 2000. Print. Cohen, Elizabeth. CDC: Antidepressants most prescribed drugs in U.S. CNN.com. Cable News Network, Inc. 9 July 2007. http://www.cnn.com/2007/HEALTH/07/09 antidepressants/index.html?_s=PM%253AHEALTH Davis, Jeanie. Drug Therapy vs. Talk Therapy for Depression. WebMD.com. WebMD, LLC. 7 September 2004. http://www.webmd.com/depression/news/20040907/drug-vs-talk therapy-for-depression Franklin, Donald. "Antidepressant Medications." Psychologyinfo.com. Forks Publishing Company, n.d.Web. 22 Mar. 2014. http://psychologyinfo.com/depression/medication.htm Murray, B. & Fortinberry, A. Depression Facts and Stats. Upliftprogram.com. The Uplift Program. 15 Jan. 2005. Web. 18 Mar 2014. http://www.upliftprogram.com/depression _stats.html#2 Psychotherapy to Treat Depression. Medicinenet.com. MedicineNet, Inc. 24 July 2012. http://www.medicinenet.com/psychotherapy/article.htm

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Sawyer Batten Dr. Bushman ENG 303 Essay 3 14 April 2014 Prater, Alicia. "Selective Serotonin Reuptake Inhibitors." Sciences360.com. Helium, Inc., 22 Mar. 2010. Web. 22 Mar. 2014. http://www.sciences360.com/index.php/selective serotonin-reuptake-inhibitors-10976/ "What Causes Depression?" Health.harvard.edu. Harvard University, n.d. Web. 27 Mar. 2014. http://www.health.harvard.edu/newsweek/what-causes-depression.htm.

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