There Is No Pill For Happiness

If they sold a pill for happiness how many of us would be taking it? That question came to mind when I read that 20% of Americans now take a psychiatric drug of some type or other—including antidepressants, anti-anxiety meds and pills to treat attention disorders.

And what segment of the population is fueling the rise of the sublimely medicated? According to an “analysis of trends” compiled by pharmacy benefit manager Medco Health Solutions, Americans across the board are turning to psychiatric drugs to “ease their mental woes” but “women lead the trend.” It turns out that one quarter of all adult women now take at least one psychiatric drug.

Here are a few highlights of Medco’s analysis, called “America’s State of Mind;” over 20% of all women are taking a drug usually prescribed for depression with some 24% of older women (over age 64) taking antidepressants, 11% of women 45-60 depend on anti-anxiety drugs and, perhaps most surprisingly, the percentage of young women (20-44) taking medication to treat attention deficit hyperactivity disorder (ADHD) rose a whopping 264 percent over the last decade. Overall, the number of women on ADHD drugs was 2.5 times higher than in 2001—putting them ahead of men in terms of sheer numbers using these drugs.

In the last decade or so a lot of attention has focused on the increasing use of psychotropic drugs to treat mood and attention disorders in children. That trend has abated somewhat when it comes to traditional antidepressants ever since the Food and Drug Administration issued a warning in 2004 that SSRI drugs such as Prozac and Zoloft increase the risk of suicidal thinking in children. Use of ADHD drugs has also leveled off in both boys and girls since a high in 2005. But use of a newer class of drugs called atypical anti-psychotics—strong medications that were developed to treat serious ills like schizophrenia and have troubling side-effects—continues to increase for treatment of depression and other mood disorders in kids. Such “atypicals” as Abilify and Serequel can lead to weight gain, increases in cholesterol levels and incidence of Type-2 diabetes in young people. Last year, a similar Medco analysis reported that use of these drugs in kids doubled between 2001 and 2010.

But the spike in psychiatric drug use among adult women stands out as the most striking finding in Medco’s current analysis. Dr. David Muzina, a psychiatrist and national practice leader for the company says that it’s not clear if more people, especially women, are “developing psychological disorders that require treatment, or if they are more willing to seek out help and clinicians are better at diagnosing these conditions than they once were.” Women, he continues, tend to be, “more frequent users of healthcare, but they may also be bearing the emotional brunt of a decade that started with the horror of 9/11 and since has seen several wars and economic turmoil.”

The failure of women to cope with an increasingly dystopian world is not a novel theory when it comes to explaining their higher usage of psychiatric drugs. In the 1960’s and ‘70s, women were prescribed tranquilizers like Valium (“mother’s little helper”) far more often then men because doctors thought that the demands of being a perfect housewife, coupled with the stifling boredom of spending the day wrapped up in menial tasks could cause neuroses in the weaker sex. In past centuries all kinds of balms and tonics were prescribed to women who were diagnosed as “hysterical” or otherwise deemed mentally unstable.

Now, pharmaceutical companies almost exclusively depict women in their print and TV ads for antidepressants, sleeping pills and atypical anti-psychotics as stressed out, depressed, unable to concentrate or failing to keep up with the demands of work, family and home life.  Will we soon begin seeing television and magazine commercials portraying more sinister, yet vague threats that include random terrorist acts, war and, perhaps more commonly, the loss of a job or a home to foreclosure? Will more of us need to take amphetamines and other attention disorder drugs to keep up with an increasingly fragmented lifestyle that includes being expected to keep up with email, text, tweeting and other assorted social media most of our waking hours while at the same time caring for children (and often aging parents), holding down a job, etc., etc. Perhaps in order to meet the demands of 21st-century multi-tasking we, like ever-increasing numbers of our children, will require drugs that focus our minds and control our (perhaps, natural) impulse to disengage.

Of course the goal for pharmaceutical companies has always been to sell more drugs and women clearly represent the current growth industry. A look at the recent history of medications promoted to treat mental illness reveals an uncanny ability to create solutions to the problems of the day (or is it the other way around?). For example, the diagnosis of bipolar disorder during outpatient visits of children and adolescents increased 40-fold between 1995 and 2003; rising from 20,000 to 800,000 in less than a decade. At the same time, the use of antidepressants among children and adolescents in the U.S. also spiked; tripling between 1994 and 2002,  “to the point where antidepressant drugs were being prescribed more frequently than acne products or eye drops for those under 18,” writes Alison Bass in her book “Side Effects.”

Still earlier, diagnosis of attention disorders in children—especially among rambunctious young boys—led to an enormous growth in sales of amphetamines and other name-brand stimulants for pediatric use. Most recently, spending on the top three atypical antipsychotics—Abilify, Seroquel and Zyprexa—grew by $1.4 billion last year, according to IMS Institute for Healthcare Informatics, with much of the growth coming from off-label use in treating depression and other mood disorders in both adults and children.

What becomes clear from this latest analysis is that there are two very different assessments of where we stand in the treatment of mental illness. According to the National Institute of Mental Health, psychiatric disorders like anxiety, depression, social phobia, and attention disorders are pretty common; “in a given year approximately one quarter of adults are diagnosable for one or more disorders.” And as the recent Medco analysis reveals, sales of prescription drugs to treat these problems are booming. This has occurred despite the troubling fact that the causes of these disorders remain largely unknown and the exact biochemical mechanism for how most modern psychiatric drugs abate symptoms are at best theoretical.

But serious mental illness—the type that is truly debilitating—affects only about 6% of the population. For this group of people—who are far more likely to be poor, unemployed, homeless or incarcerated—mental illness is too often unrecognized and undiagnosed and treatment is far less likely to be adequate. Many health professionals believe that serious mental illness among children and adolescents; the type that leads to substance abuse, serious eating disorders and violence is also under-recognized. According to the National Alliance on Mental Illness, “In any given year, only 20 percent of children with mental disorders are identified and receive mental health services.” Note that when NAMI mentions “mental health services” they are not only referring to only medication; lower-income children and adults covered by Medicaid are more likely to be medicated than to receive psychological counseling and services that could provide far more lasting results. Since 2009, states have cut more than $2 billion from mental health programs and shut down more than 4,000 inpatient beds, I reported earlier this year in a post on the blog HealthBeat.

In the end, what we derive from Medco’s latest snapshot of “America’s State of Mind,” is that a good portion of our nation is under psychic distress. This may be a windfall for pharmaceutical companies, especially as they advance marketing campaigns that push all the right buttons—sending many of us, especially women, to their doctors to ask for Abilify, Concerta, or whatever name-brand drug is soon to emerge from the pipeline. But of course, the issue is much more complicated and it speaks to the fact that as we consider health reform, we must also begin to grapple with the complicated and still-uncharted issue of mental health reform. Sadly, there is no pill for happiness; solving any of our “mental health woes” will require a stronger dedication to brain research, more resources for treatment programs and a frank consideration of the socio-economic factors that got us here.