Young adulthood, depression, and anti-depressants
A recent article in the New York Times (4/17/2104) The Antidepressant Generation by Doris Iarovici M.D. raises some important points about the use and possibly over-use of anti-depressant prescriptions for young adults.
There is little doubt that anti-depressants can offer great relief to adults struggling with paralyzing depression, when they are having difficulty functioning in their life.
But walk into your primary care provider’s office, break into tears, complain of poor sleep, anxiety, and sad mood and you will likely walk out with a prescription for an anti-depressant even though you don’t have the symptoms of major depression.
But perhaps the larger concern, according to Dr. Iarovici, is that once an adult is prescribed an anti-depressant, they may stay on it for years—regardless of whether they still need it.
Clinical guidelines recommend that individuals with an initial episode of depression stay on the medication for six to nine months. After that interval (unless you are in the middle of a Northwest winter!), adults should taper off of the medication.
Adults are often advised to taper down on these medications when they are in a relatively transition free time. Otherwise, it is hard to determine whether an individual is struggling with normal life challenges or depressive symptoms that resurface after discontinuing the medication. The problem—young adulthood is rarely transition free! The period between 18-29 is filled with new challenges, transitions, relationship crises, and situational stress.
So when young adults do go off their medication how will they know if their response is caused by their current situation, tapering off of the drug, or the reemergence of another episode of depression?
“Major depression in adults is often recurrent: half of people with first episodes will have a second episode. The current standard of care is to recommend medicine indefinitely after three or more recurrences..” notes Dr. Iarovici.
These recommendations are based on studies of all adults, regardless of age. Some of this research was funded by pharmaceutical companies who have a financial stake in these findings.
At the same time, young adulthood is challenging. Youngsters are bumping into numerous “firsts”-- major relationships, difficult classes in college or graduate school, and new careers. These novel experiences can catapult a youth into episodes of major anxiety, sleeplessness, helplessness, and disappointment. The goal is to develop coping skills, insight, awareness, and self-confidence. It’s all about learning from your experience.
This is where psychotherapy is especially helpful. But currently, medication is less expensive in the short run. A prescription for generic Prozac (Fluoxetine HCL 20mg) is about $7 per month! Weekly counseling, with a $25 per visit co-pay, would cost a patient a $100 monthly, after a deductible is met ($250-$1500). There’s a big difference. Indeed most studies show that for moderate to severe depressive episodes, the combination of medication and therapy are more effective than medication alone. Drug companies spend millions of dollars a year on television and magazine ads hawking the benefits of anti-depressants. It’s no wonder that anti-depressants are among the most dispensed drugs in America!
What’s the take home message? It’s complicated. It’s hard for a young adult to assess how to handle big bumps in the road. A long term relationship with a primary care provider that knows you well can help you sort out what approach is best for you. A mental health clinician can help you consider your alternatives. If you are on an anti-depressant for a first time depressive episode, discuss how and when to taper off the medication with your prescriber. Consider combining therapy and medication.
Dr. Iarovici—“We walk a thinning line between diagnosing illness and teaching our youth to view any emotional upset as pathological. We need a greater focus on building resilience in emerging adults”. I agree.
What do you think?