Depression and anxiety are more prevalent than ever before.
The statistics are sobering and frightening. Five times more people take antidepressant drugs today than just three decades ago. One in six American adults takes at least one psychiatric drug during a year. The situation is worse for women. One in five women take a psychiatric drug, double the rate for men. Some clinicians say these rates underestimate the actual rates because many cases go unrecognized and, therefore, untreated. What’s happening there?
I have noted this throughout my career. The majority of patients in my practice are women, and 20-plus years ago it was unusual to see patients on drugs for depression and anxiety. Now, it seems most patients are, either chronically or on an as-needed basis. This is issue for me because patients who take these types of drugs on a regular basis may become resistant to the types of medications I use to sedate patients for surgery. Such patients sometimes tolerate doses of sedatives that would put down a horse. It makes surgery more difficult, and dangerous.
Even more concerning, however, is the possible long-term effects of being on such drugs. The top 10 psychiatric drugs used by adults in the United States are Zoloft, Celexa, Xanax, Ambien, Prozac, Desyrel, Klonopin, Ativan, Lexapro, and Cymbalta. Eight of the 10 cause withdrawal symptoms when stopped or are classified as Schedule IV drugs by the Drug Enforcement Administration. This means there is possible risk of creating dependence and/or abuse. Ambien, for example, is a widely prescribed sleep aid. It is intended for short-term use, but I have seen many patients who have been on Ambien for years and take it more nights than not to help them sleep. Over time, they become physically and psychologically dependent on Ambien.
Many potential problems exist with long-term use of psychiatric drugs. First, we really do not understand well how they work. Second, we do not know the long-term effects of these drugs on the human body because many have not been around long enough to gather data.
We know they, like all drugs, have side effects, some of which can be serious and even life-threatening. A listing of these is too extensive to include here. Suffice to say they are not without risks, making it imperative they be prescribed judiciously and monitored carefully. For some, once you’ve been on them for a while, you cannot simply stop taking them. In addition to withdrawal symptoms, there is the possibility of worsening anxiety or depression, and suicides are not unheard of. This is why close cooperation between patient and physician is so important.
It’s important to know why. Why have anxiety and depression become the most prevalent mental illnesses? Why are so many women having issues with anxiety and/or depression? Is life more stressful now? Although it is difficult to come by statistics for depression and anxiety from a generation or two ago, it is widely agreed that we are seeing the highest rates of these conditions in history. Some leading psychiatrists call it an epidemic. Perhaps we are better at diagnosing them today than decades ago. We just don’t know. Another concern is whether we are too liberal in prescribing these drugs rather than trying to deal with anxiety and depression through non-pharmaceutical means. The latter takes time, and, in this time-pressured age, many physicians do not have, or will not take, the time to do anything but prescribe a drug.
Anxiety and depression are real conditions that range from mild to debilitating and may be life-threatening at times. Women dealing with these issues should follow certain steps to get proper treatment:
- Seek to identify aspects of your life creating your feelings of anxiety and depression. If you can, change them. Situational anxiety and depression often resolve with change.
- Tell your primary physician if you are depressed or anxious. It is not a character fault or failing. It is not shameful or indicative of weakness. It simply is, and may be due to genetics, environment, and circumstances.
- Follow your physician’s instructions to the letter if you are prescribed medication(s).
- Seek periodic, regular follow-up to verify whether you need to continue the medication(s).
- Do not stop any medication without notifying your prescribing physician.
- Be wary of physicians who seem quick to prescribe medications without spending time to learn more about you and your condition and/or who do not do regular follow-up to assess your condition.
- Never share medication(s) with friends or family who may have the same issues. I see this a lot and it is extremely dangerous. If they need medication, it should come from their physician.