How to Make Sense of America’s Ongoing Increase in Antidepressant Use

And what it means for the culture of mental health.

Image courtesy of Flickr.

More and more Americans are getting psychiatric help. But not all of it is coming from psychiatrists.

According to new data from the National Center for Health Statistics (NCHS), between 2011 and 2014, 12.7 percent of people surveyed (aged 12 or older) reported taking an antidepressant in the previous month. As Thrive Global has reported before, that’s a 64 percent increase from 1999 to 2002, when 7.7 percent of respondents reported taking antidepressants.

Like just about any big social trend, the increase in antidepressant use has multiple causes.

Laura Pratt, the lead author of the report and a NCHS psychiatric epidemiologist, tells Thrive Global that the increase may be due to shifting cultural norms. “The stigma of mental illness is hopefully falling,” she says. “The drugs are safer, and depression has been really historically undertreated.”

Mark Olfson, a professor of psychiatry at the Columbia University Medical Center who studies the delivery of mental health services and was not involved in the study, sees the trend tracking back to the 1980s, when fluoxetine, commonly sold commercially as Prozac, was introduced. The uptick has to do with America’s aging population, the tendency for patients who start antidepressants to stay on them and increased public acceptance of the medications, he adds.

The docs who prescribe them are another key facet to all this. “Primary care physicians and other non-psychiatrist physicians account for a majority of antidepressants prescribed in the United States,” Olfson says—research indicates that almost four out of fives antidepressants are prescribed by non-psychiatrists. It can be read as a supply and demand issue: there just aren’t enough specialists to handle all the care needed for people with depressive and anxiety disorders. That also means, Olfson adds, that primary care docs will continue to have a big role in prescribing antidepressants for the foreseeable future. 

While there’s no clear conclusion to be made that this leads to an increase in inappropriate or unnecessary prescriptions, it’s a point that’s not without controversy: a 2011 study found that nearly three-quarters of antidepressant scripts are written without a specific diagnosis, and according to CDC data, they’re the third-most prescribed class of drugs. Meanwhile, how effective they are remains unsettled. Non-pharmaceutical treatments are also promising: mindfulness-based cognitive therapy has been found to reduce relapses in people who have recovered from depression as effectively as medication.

Olfson says that extending access to psychotherapy remains a key challenge, as does ensuring the quality of care for patients who are being treated by generalists like primary care doctors. If you think you may be suffering from depression, you may want to start working with a therapist—a recent review found that when people find the right match, they can see reductions in levels of neuroticism, a personality trait that predicts depression, in months that would otherwise take years. 

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