The Depths of Depression
Writer(s): Stephanie Swendsen
Depression is a growing epidemic in todays society. According to the National Institute of Mental Health (NIMH), depression affects approximately 14.8 million American adults in a given year. With the illness affecting nearly seven percent of the adult population, people want answers. However, there are no clear, definitive answers when it comes to the mental illness. There is no single cause of depression. A combination of psychological, biochemical, genetic and environmental factors contribute to its development. Depressive episodes can be triggered by a traumatic event, tragic illness or injury or chronic stress a.
College students are no exception to this growing trend. According to a study by the National College Health Association, 45 percent of college students reported feeling so depressed its difficult to function at least once in 2007.
Tobin Richardson, who received a masters degree in counseling from Ball State, interned at the campus Counseling Center and says the major life changes that college students face can lead to depression. These changes can include anything from environmental factors, such as diet or substance abuse, to the pressures and stress brought on by a more intense workload, he says.
For new, incoming students, especially, making so many new adjustments is one of the biggest factors, Richardson says. They think when they come to college it will be some great party, but it ends up being so much different than anything theyve ever known. The changes can be really hard to deal with, especially if they dont have friends and because they dont see their family everyday anymore. Adjusting to new independence can be really tough.
Dr. Carolyn Kapinus, associate professor of sociology at Ball State, believes that societal influences have been a major contributing factor to the nations high depression rates.
I think when so many people are suffering from depression and prescribed antidepressants, it says something about the culture and something about our society, that modern life is kind of creating this situation where a lot of people are suffering from depression, she says.
Dr. Kapinus believes that todays society is suffering because people feel less connected to immediate friends and family than ever before. She says that, although social networking may increase some forms of interaction, it does not have the same benefits of the face-to-face connections were lacking. She also points out that our societys focus on the self-esteem movement may also be a contributing factor for younger generations.
The emphasis on self-esteem contributes to the increase in depression in that were not really teaching people to deal with failure, Dr. Kapinus explains. So if people dont know how to deal with failure, it makes sense that they are going to react by being depressed rather than figuring out how to overcome obstacles. I think thats why were seeing more depression in this particular age group than weve seen in prior years.
But one of the most controversial arguments surrounding the trend in depression is the impact the prescription drug industry has made in selling sickness. The United States and New Zealand are the only countries in the world in which direct-to-consumer (DTC) advertising of prescription drugs is legal. DTC promotion includes newspaper, magazine, radio, television and outdoor advertising. And according to IMS Health, U.S. prescription product companies spent more than $4.3 billion on DTC advertising in 2009 alone.
Some argue that because these companies are investing billions of dollars into advertising every year and utilizing marketing tactics to sell their products, consumers are frequently manipulated and misled. It is argued that antidepressant DTC advertisements cause consumers to self-diagnose their feelings of sadness and depression, thus leading them to want and request the medication.
But while theories of why depression has become such an epidemic in the U.S. continue to be debated, one thing cannot be argued: Antidepressant prescriptions are at an all-time high.
In an article in the New Yorker, Louis Menand says that once the F.D.A. approved Prozac in 1988, the number of adults prescribed to antidepressants tripled by 2000. He raises the argument that pharmaceutical companies may be increasing antidepressant sales not only by influencing consumers to believe they are depressed via DTC advertising, but also by encouraging that the medications be prescribed to treat other conditions, such as eating disorders, panic attacks, premature ejaculation and alcoholism.
In 2009, antidepressant prescriptions totaled 168.7 million in the United States, according to IMS, and sales totaled $9.9 billion. Although drug companies may have incentives to bolster antidepressant sales, they are not the only ones to blame.
Today, our society is more inclined to treat depression with a pill as a first solution, Dr. Kapinus says. Changes in societal rituals, such as grief, may contribute to the trend.
I dont think were comfortable in this culture dealing with grief or really traumatic life events, Dr. Kapinus says. If we think about things 100 years ago, or in the early 21st century, people had a set time to grieve. They actually wore black clothes or armbands even to send out a message to people that Im grieving somebody, and people understood that and made adjustments for that.
Without such rituals allowing people time and space to grieve or telling people that its normal to feel sad, society is less comfortable with those feelings, she says. Therefore, people may feel like they arent functioning correctly and seek a pill to overcome those feelings quickly and make them normal again.
Richardson says living in such a fast-paced society may lead to people over-utilizing antidepressants and under-utilizing talk therapy.
Its a product of society, he says. Everyone is looking for that quick fix.
Even though Dr. Kapinus believes the social stigma on health problems is lessening, she also thinks a stigma remains when it comes to seeing a therapist versus taking a medication. She says that seeing a therapist is often associated with having a personal, emotional problem; whereas, taking a pill in order to combat a chemical imbalance may seem more like a medical illness.
According to the National Instiute of Mental Health, antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.
But why is the number of people prescribed to antidepressants such a concern? Because some research indicates that antidepressants may actually do more harm than good.
There are different types of antidepressants, but those that affect serotonin levelsselective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly used worldwide. Side effects include headaches, nausea, insomnia and nervousness, agitation, and sexual problems (reduced sex drive, erectile dysfunction, delayed ejaculation or inability to have an orgasm).
Some SSRI and SNRI even report sensations similar to an electronic-shock in the brain. Gwen Warren*, a recent Ball State graduate, says she suffered from the sensations multiple times a day while prescribed to Effexor, one of the most popular SNRIs.
Brain zaps, brain shiver, brain shock, it feels like an electrical shock right in your brain, followed by an unbalanced and dizzy feeling. Ive had a headache before, but Ive never felt like my brain was literally being zapped, Warren says.
However, these side effects arent even the biggest concern. In 2005, the FDA made new label changes, requiring antidepressant manufactures to add a black-box warning describing the increased risk of suicidal thinking and behavior in children and adolescents. These changes were made after the FDA conducted thorough research of both published and unpublished controlled clinical trials of antidepressants involving nearly 4,400 children and adolescents. The FDA also required that labels emphasize the importance of appropriate monitoring and close observation for suicidal behavior. The warnings, however, did not include young adults.
But a year later, after another comprehensive review involving almost 300 individual antidepressant trials, including more than 77,000 adult patients, the FDA found that suicide risks actually doubled. Label changes were required once again, this time including a warning for young adults.
There is also a lot of controversy surrounding what is commonly referred to as the antidepressant discontinuation syndrome, in which symptoms that actually mimic those of depression may occur after patients stop taking these medications.
According to the American Academy of Family Physicians, Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal.
But just as the reason why the chemical effects of antidepressants are effective for some is unknown, so is the reason why some experience withdrawal.
In an article in from the Los Angeles Times, Regina Nuzzo explains that, although antidepressants increase levels of brain chemicals, some researchers believe that it also slows down the transportation of the chemicals. Therefore, when someone stops taking the medication, it takes time for the transportation system to adjust and regain itself.
Abrupt changes in medication doses may increase the severity of withdrawal symptoms, which can lead to suicide. It is strongly suggested that patients talk with their doctors to determine the best tapering regimen. But unfortunately, this doesnt always occur.
After Warren had been taking Effexor for several months, her doctor switched her prescription to Pristiq due to a change in her health insurance. However, her doctor failed to implement a tapering plan or warn her of the potentially life-threatening withdrawal symptoms. Warren says she never had suicidal thoughts in her life, but that quickly changed.
A few days into my new prescription, I couldnt help but mutter to myself, Just do it. Just die. Just kill yourself, Warren says. It became similar to a mantra. I kept thinking about it over and over again, murmuring it underneath my anxious breath, as if it were my sole goal.
Overcome by suicidal thoughts, her situation quickly escalated.
When I frantically stroked the knife across my arms and wrists, I was hoping for an end to the sad, withering, chest-tightening feelings I couldnt escape, Warren says. My skin broke against the blade, blood began to seep out and my usually comfortable home kitchen turned into a foggy, uncontrollable scene.
While the risks involved with antidepressants may be incredibly dangerous, not treating depression can be just as hazardous. In moderate to severe cases of depression, Richardson says that taking an antidepressant in conjunction with psychotherapyor talk therapyis the best option. However, for mild and some moderate cases, talk therapy is an effective treatment by itself. Anyone on an antidepressant should be going to therapy, but not necessarily the other way around, he says.
Antidepressants only focus on the symptoms, not the underlying root cause, Richardson explains. You can compare it to breaking a bone, and instead of getting actual medical treatment, you just took painkillers. Your bone is still broken and you still need to get it fixed. Antidepressants can make you feel better, but its not a long-term treatment. People only stay on antidepressants for six months to a year, and there is probably an underlying problem that needs dealt with, which you do in therapy.
But for less severe cases of depression, sometimes making lifestyle adjustments can be an effective. Both Richardson and Dr. Kapinus say lifestyle changes, such as increasing exercise, can help to alleviate symptoms of depression in some cases. Dr. Kapinus says diets that are high in sugar can lead to mood swings and feeling depressed. Incorporating meditation or relaxation techniques, and deep breathing techniques can also be beneficial, Richardson says.
After Warrens suicidal episode, she began looking into what lifestyle changes she could make to help overcome her depression. But deciding whether or not to continue her prescription and trying to take matters into her own hands has been a daunting task.
At this point, Im carefully and skeptically following the advice of my psychiatrist. Ive never been very interested in consumer culture, or the Prozac nation, and would prefer to be pill-free, Warren explains. One of the biggest things, for me, was finding the strength to help myself, a strength thats not easily found in the numbing depths of depression.
Today, Warren incoporates vitamin supplements with a vegetarian diet, but her diet isnt the only thing shes changed.
Holding on to dear life, to my dear friends, tension tea, my family, self-help books and forcing myself to smile for 30 seconds are all things that have been beneficial to me in the most natural way possible, she says.
But like so many others in her situation, Warren is just trying to find the best way to beat her illness once and for all. There is no cure for depression, so its up to people to find the treatment that best suits them. For many, psychotherapy is the best option. For others, antidepressants may still be the answer.
I think the bottom line is people have to do their homework and do their research on their particular drug and know what theyre getting themselves into, Dr. Kapinus says.Return to top