The overmarketing of antidepressants.(Interview)

Janet Currie, a health policy analyst and researcher in Vancouver, has written a report entitled The Marketization of Depression: Prescribing SSRI Antidepressants to Women, recently published by Women and Health Protection (WHP), a coalition of Canadian community groups, researchers, journalists and activists concerned about the safety of pharmaceutical drugs. In her report, Currie documents the enormous growth and widespread use of Selective Serotonin Reuptake Inhibitors (SSRIs) in Canada, a phenomenon that also exists in the United States and other Western countries. (SSRI brand names include Prozac, Paxil, Zoloft, Effexor, Celexa, Remeron, Lexapro and Luvox.) For example, in 1999, more than 8.8 million prescriptions for SSRIs were filled in Canada. In 2003, that number jumped to more than 15.5 million.

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Women are twice as likely as men to receive a prescription for SSRIs. The rates for menopausal women are among the highest. Currie notes that, of all the women in British Columbia taking SSRIs, 17.94% were between the ages of 50 to 54 and 18.94% between ages 55 to 59, compared to 11.17% of women 25 to 29. (Only women past the age of 80 had higher rates of prescriptions, at 19%. Currie believes this is due to the fact that elderly women tend to go into care homes where psychiatric medication is often prescribed, particularly for sedation.) In an interview with A Friend Indeed, Janet Currie sheds more light on the upsurge in antidepressant use.

Q: Why are menopausal women more likely to be prescribed antidepressants?

A: Menopause is a natural transition that some women find challenging because of the psychological and physiological changes that take place. These women may be juggling many balls--caring for teenage children, making mid-career changes, or managing the chronic conditions of their elderly parents--and menopause may be just one ball too many. They are conscientious women who may become concerned that they won't be able to function, so they go to their doctors looking for help. Instead of reassuring their patients that they can make it through, doctors hand them a prescription for an antidepressant. In a survey conducted by IMS, a medical data gathering company, 80% of visits for depression resulted in a drug prescription.

For many years, women's normal life processes and reactions to life events have been medicalized and labeled disorders or illnesses. Hormone Replacement Therapy is a case in point. We came to believe that menopause was nothing more than a hormone deficiency that could be remedied even though low estrogen is normal for our age. Why did women fall for that? And then when the 2002 Women's Health Initiative Study showed that HRT increased the risk of heart disease and breast cancer, many women stopped taking it. For a brief period, antidepressants were recommended as a treatment for hot flashes, although this is an off-label use. Thankfully, that doesn't seem to be the case anymore. But now, we're being told that depression is a chemical imbalance that can be fixed with a pill. SSRIs are prescribed for a whole range of life problems, which may cause distress but are not serious disorders--things like adjustment to retirement, fatigue, and relationship problems with husbands or children.

Q: In your report, you drop the bombshell that there is no scientific evidence for serotonin imbalance in depressed people.