On the health front

Let's throw in a bit of a change up - depression. Yeah, I know reading Uncommon Thought is enough to depress a comedian. But seriously, there seems to be an epidemic of depression in the US - at least if antidepressant prescriptions are any indicator. According to Express Scripts Drug Trend Report for 2002, antidepressant use grew 15.6% in 2002 alone; making it the second most widely used class of drugs. Antidepressant perscriptions contributed 15% of the total increase in prescription drugs for 2002. Part od the growth in the use of antidepressants is due to expanding the conditions they are prescriped for - anxiety disorders, PMS, and PTSD, (and I would add chronic pain conditions).

I personally feel that it has to do with the pace of life required in the US in combination with unrealistically high performance expectations. It is no surprise then if I see depression as (at least in part) a social environment issue, and that I have had long term concerns about taking antidepressants to "cure" the problem. Well, that concern was validated by two recent reports: Nearly one-fifth drop out of Lilly antidepressant drug trial after participant's suicide (AP, 2/12/04), and U.S. expands antidepressant warning (CBC, 3/23/04)

The CBC reports that the FDA has sent warnings out to doctors that they should monitor patients on 10 different antidepressants for suicidal tendencies.

Drug regulators in Canada, the U.S. and Britain have warned that children and teens taking antidepressants may be at greater risk of committing suicide. Monday's advisory expands the warning to include adults, and asks drug makers to add warnings about the possible risks to their labels.

Most of the antidepressants in the warning are selective seratonin re-uptake inhibitors or SSRIs , which work to raise serotonin levels in the brain. It's thought that reduced transmission of serotonin plays a role in depression.

The drugs included are the SSRIs (selective seratonin re-uptake inhibitors). Specifically: Prozac, Paxil, Zoloft, Effexor, Celexa, Remeron, Lexapro, Luvox, Serzone, and Wellbutrin.

Now one thing, in my lay opinion, that might be causing an increase in depression is sleep deprivation. I see a lot of this in my students, (and experience a fair amount of it myself). In that vein, a recent study found that Even Babies Don't Get Enough Rest (NYT, 3/30/04). In fact, the study states that infants are averaging an hour and a half less sleep than the 14 hour minimum that doctors recommend. In support of my suspicion about life style issues, the article states (emphases mine):

Dr. Mindell and other sleep experts say that young children who do not sleep enough do not function as well as their better-rested classmates at school and that their relationships with family and friends suffer. Infants and toddlers also need enough sleep to remain alert and open to the world around them, the experts say.

Dr. Lewis Kass, a pediatrician and the director of the sleep disorders center at the Children's Hospital at Montefiore in the Bronx, said the findings were significant because they provided firm data for a phenomenon familiar to pediatricians.

In many families today, he said, even small children take part in so many activities that sleep patterns are inevitably disrupted. "This puts in terms that people can grasp how big a problem this is," said Dr. Kass, who was not involved in the survey.

Pediatricians do not pay enough attention to the issue, according to the poll, with 52 percent of parents reporting that their children's doctors do not ask about sleep habits. Some parents also lose as many as 200 hours of sleep a year because of their children's poor sleeping patterns, the survey found.

...

Experts say they sense that small children get less sleep and have more sleeping problems than they did in the past, though they acknowledge they have little evidence. Still, most attribute the problem to the current patterns of daily life.

"All of the pressures of today's 24-7 society are not just affecting adults but are filtering down to our children," Dr. Mindell said. "This is a warning that we need to pay as much attention to the sleeping half of children's lives as the waking half."

Therefore, it should come as no big surprise that it is no only adults who are taking more antidpressants - Antidepressant Use Way Up in U.S. Kids, Report Says (Reuters, 4/02/04). According to the article, the fastest growing antidepressant use group is ... preschoolers ... their use rate doubled between 1998 and 2002. Doubled in four years!

Express Scripts, which keeps statistics on drug use, said the number of prescriptions written for antidepressants is growing by about 10 percent a year in children and adolescents.

The study looked at a random sample of 2 million children covered by commercial insurance between 1998 and 2002. Among children under age 5, the number of girls being prescribed an antidepressant doubled and the number of boys went up by 64 percent, the group reported.

It doesn't then seem too surprising that youth suicides are also jumping rapidly. According to the Child Trends Databank, "The teen suicide rate increased from 5.9 to 11.1 per 100,000 between 1970 and 1994. " And then we have this from the National Center for Injury Prevention and Control:

Suicide Among the Young

* Persons under age 25 accounted for 15% of all suicides in 2000.1 From 1952-1995, the incidence of suicide among adolescents and young adults nearly tripled. From 1980-1997, the rate of suicide among persons aged 15-19 years increased by 11% and among persons aged 10-14 years by 109%. From 1980-1996, the rate increased 105% for African-American males aged 15-19.1,8

* For young people 15-24 years old, suicide is the third leading cause of death, behind unintentional injury and homicide. In 1999, more teenagers and young adults died from suicide than from cancer, heart disease, AIDS, birth defects, stroke, and chronic lung disease combined.1

* Among persons aged 15-19 years, firearm-related suicides accounted for more than 60% of the increase in the overall rate of suicide from 1980-1997.1

The risk for suicide among young people is greatest among young white males; however, from 1980 through 1995, suicide rates increased most rapidly among young black males.9 Although suicide among young children is a rare event, the dramatic increase in the rate among persons aged 10-14 years underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group.

There may be yet another contributing factor in both depression and suicide. As is widely noted, those in the US have lousy dietary habits which apparently result in a fair amount of gasto-intestinal disorders. Ads for treating these conditions are all over the television. Side effects from these medications (now sold over-the-counter in an unregulated way) have their own side effects. Axid, Tagamet, and Pepcid all have depression as a side effect. Tagamet additionally has psychoses/hallucination, confusion/delerium, dementia, and sexual dysfunction as possible side effects. The last three side effects are shared by another common drug - Zantac.

The need for these gastro-intestinal drugs is being driven by life style structure in the US, as is sleep disorders, as is anxiety and depression. We are utilizing a wide array of drugs to keep people functioning in the dysfunctional social environment we have created. Each drug entered into the mix has its own side effects. The more widely used a drug is, the more prevalent those problems are within the society (more people experiencing side effects). Of course, no one seems to be looking at the effects of drug combinations in the general population - folks taking multiple over-the-counter and prescription drugs.

While I don't want to extend this article into yet another topic, these drugs have a larger effect than in the human population. They are having a dramatic environmental effect as they enter our water ways as they are excreted from the humans taking them. If you are interested in this part of the problem, I recommend the following articles: New study says pharmaceutical wastes taint US waters, Drug Flush - Lake Mead, and More waters test positive for drugs.

Isn't "modern life" complicated?

Update - related article: 4/04/04 Cockburn, CounterPunch, Anti-Depressants a Problem? We're Shocked!

Posted by rowan at April 3, 2004 10:55 PM | TrackBack | [eMail this article!] |