Sunday, July 15, 2012

Prozac is no longer considered to be so transformative—or even so effective. According to the research of Harvard Medical School’s Irving Kirsch, selective serotonin reuptake inhibitors (SSRIs), the broad category of drugs including Prozac, Zoloft, and Lexapro, are more effective than placebos only in cases of severe depression.

But 10 percent of the American population continues to take them because the message from psychiatrists and from the culture more broadly is, “Why not?”

We still don’t have a conclusive answer about whether antidepressants work, or about their long-term effects.

Wonder drugs or not, it is now considered culturally acceptable to take SSRIs indefinitely. Psychiatrists often prescribe them without an endpoint, and this attitude toward prescription has changed the way depression is conceptualized. Only two weeks of symptoms are required for a diagnosis, but then—somewhere along the line—depression becomes a lifelong disease that requires lifelong drug treatment. When it comes to therapy, insurance companies are moving in the opposite direction, often paying only for short-term treatment. So we are left wondering: does depression last forever, or can it resolve itself in 20 sessions? Can the drugs do the trick?

Am I a different person on antidepressants? Is life without antidepressants somehow more authentic?

These questions are especially pertinent and confounding when they are asked by people who began taking SSRIs in adolescence. While adults can make an informed decision about whether they want to subscribe to the narrative that SSRIs will restore them to their pre-depression selves, adolescents have not yet fully developed the personalities that could serve as points of comparison. The self on antidepressants becomes the only self they know.

There is a widely accepted but never conclusively proven idea that depression is caused by a chemical imbalance in the brain. The rise of this biomedical model of depression was used by “big pharma” to reassure consumers that SSRIs were designed to treat a disease not unlike, say, diabetes. The key date in the story is 1997, when the FDA removed the regulation against direct-to-consumer advertising, making it possible for large numbers of people to go to the doctor specifically to request SSRIs.

The idea of a psychopharmaceutical as a quick fix is nothing new, but the ease with which antidepressants are now prescribed is carrying over into yet another, more troubling class of drugs: atypical antipsychotics, designed to treat diseases like schizophrenia. Sharpe mentions the rise of these drugs as a means of managing childhood behavior problems, but she doesn’t discuss the fact that they are increasingly used in the general population to supplement antidepressants, often with serious side effects.

After 25 years, the chemical treatment of depression may just be getting started. And if SSRIs are changing who we are, we’re still figuring out how.

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