Diseases - Depressing Statistics

How real is depression? A few people genuinely suffer from a mental condition known as major or clinical depression. They are passive, withdrawn, and cannot work. They sleep poorly and have suicidal impulses. They lose interest in pleasure, including sex. They lose or gain weight. The condition lasts for several weeks at a time and is recurrent or chronic. Such people cannot function normally. Major depression may eventuate in suicide. In reading what follows, it is well to keep in mind that there are real cases of depression that require medical attention. People with the symptoms just described may be a small or a large proportion of those who have depression.

It is difficult to find believable statistics about this condition. Numbers are thrown about without much evidence: 15 or 19 million people suffer from depression; 800,000 children have clinical depression. So it goes. The closest thing to a statistical tracking comes from the National Ambulatory Medical Care Survey (NAMCS) conducted by the Department of Health and Human Services. Trained interviewers talk to physicians engaged in private patient care. The survey reports, among many other things, the reason why patients visit doctors and what drugs the physician mentions on the patient's record.

The graphic shows the number of patients who went to doctors because they felt depressed. In 1989, for instance, 7.4 million visits to doctors were motivated by depression — of a total of 693 million visits, or 1.06%. In 2000, 10 million visits out of 824 million (1.22%) were occasioned by depression. This is a 37% increase in depression-driven visits. Population has only creased 12% in this period. How real is depression? In the period 1989 to 1992, antidepressants did not make it into the top 20 drugs mentioned by doctors on their patient records in any single year. In 1999, two antidepressants made the top 20: Zoloft was 14th, Prozac 16th.

Prozac was introduced in January 1988 — a year before the data shown here. Before that time — and still continuing — serious depression was/is treated using tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, and selective serotonin re-uptake inhibitors. These medications all affect brain chemistry and are used to treat a variety of mental problems. Older versions have more undesirable side effects than the newer medications; some require special dietary cautions. For these reasons, the medical community has closely monitored their use. Lithium and thyroid supplements must sometimes be used in conjunction with the older antidepressants.

Prozac became a popular drug for the treatment of depression. It caught some kind of public mood or wave. A best-selling book, Listening to Prozac, was published in 1993. Sales of Prozac — and possibly patient visits to doctors — may have shot up in response. The next year a book with a more negative message — Talking Back to Prozac — had the opposite effect, suggesting that, above a certain clinical level, where real suffering is going on, depression, and its medication du jour, may be a social response to the stresses and strains of ordinary life.

This impression is backed by the demographic profile of those who make appointments with their doctors to have depression treated. The largest group (41% to 44% of visits, depending on year) is aged 25 to 44. These are people in the prime of life — and the women are in the childbearing range. They are overwhelmingly white (92%) and two- thirds are women. One imagines millions of mothers raising children while working in high-stress jobs, more and more of them single mothers… As discussed elsewhere in this book, a version of Prozac, with another name, has been introduced specifically to treat premenstrual syndrome.

The rising incidence of depression — and the methods and hype associated with its treatment — appear to be a social trend: to convert life's ordinary and extraordinary stresses into medical conditions that create lucrative markets. A minority have a clinical condition — a majority may be seeking relief from stress. Many seem to welcome this approach, others find it depressing, but we may just be undergoing a change in our drugs of choice. In 1990, North American alcohol consumption was twice the world average. In 1999, U.S. alcohol consumption was the same as the world average. And cigarette consumption per capita in the U.S. fell nearly 28% between 1989 and 2000.

Source: U.S. Department of Health and Human Services. National Ambulatory Medical Care Survey, 1989 through 2000. Online. Available: http://www.cdc.gov/nchs/about/major/ahcd/adata.htm.