Published on Wednesday, September 2, 2009 by The Toronto Star

Pills and America's Pursuit of Happiness

by Mitch Potter

WASHINGTON – Of all the bitter pills Americans are swallowing nowadays, from joblessness to home foreclosures to runaway national debt, it might come as no surprise that a pill of another sort is flying off the shelves at a recession-defying pace – the antidepressant.

(flickr photo by Antanith used and adapted under Creative Commons license)

It's an easy jump to conclude that hard times are turning the country comfortably numb, as the Washington Post suggested in a weekend report on the sales of the drug Cymbalta, up 14 per cent since the summer of 2008 and now among America's most popular happy pills.

Drill deeper and you will find that the U.S., though far and away a world leader with its $10-billion-a-year antidepressant habit, is not alone.

Over the summer, British politicians fretted over the impact of recession on mental health amid data showing a spike of 2.1 million antidepressant prescriptions last year, when the downturn took its first precipitous dive.

Same in India, where pharmaceutical firms reported a 20 per cent expansion of the antidepressant market in the year ending December 2008. And in New Zealand, where the global plunge was linked to reports of a near doubling in antidepressant prescriptions between 2002 and 2008.

But drill down deeper still and the story behind the flurry of cause-and-effect headlines is far more nuanced.

While many researchers acknowledge there is likely an uptick in med sales as a consequence of the poor economy, most say it is driven as much or more by trends decades in the making.

There is no question America loves its happy pills, but consumption was skyrocketing long before the Dow melted down.

The real story, in fact, may be that the link between recession and mental health points in precisely the opposite direction – the possibility that people in the most dire straits today are also the most likely to be suffering depression but without access to any medical help.

That is what Dr. Craig Pollack of the University of Pennsylvania discovered during a study of 250 Philadelphia homeowners on the brink of foreclosure. Pollack's findings, published last month, showed 37 per cent of the distressed homeowners suffered from major clinical depression. But nearly half of his study group said they were too poor to buy prescription drugs.

"Clearly for some, poor health leads to foreclosure. And for others, foreclosure may be leading to poor health," Pollack said.

Dr. Ronald Dworkin, a Maryland anaesthesiologist and senior fellow at the Hudson Institute, warns that to make too much of the recession's role in prescription drug-taking is to wildly underplay the larger story of how the country has swarmed toward the pill bottle every since the 1970s, when Valium hit the scene.

"America is all about the gratification of pleasure. We are the kings of pleasure and proud of it," said Dworkin, author of Artificial Unhappiness: The Dark Side of the New Happy Class.

"But the other side of it is that we're not very good at preparing for or dealing with unhappiness, which of course is an inevitable part of life. And what we've done since the '70s is to transform into a culture that treats unhappiness as a disease."

Dworkin says primary-care doctors wrote about 75 per cent of the more than 164 million antidepressant prescriptions dispensed in 2008 in the U.S., a fact he says gainsays the notion that psychiatrists and big pharma are to blame.

But however one tracks the evolution, Dworkin contends the practice of "stupefying ourselves to cure everyday unhappiness" treats the symptom, not the cause.

And that is a bigger problem today than it used to be, given the surfeit of unhappiness associated with recession.

"There is a paradox: taking antidepressants makes people feel better, thereby reducing their interest in actually doing something about the things in their life that cause the unhappiness," he said.

"Research indicates that people in bad dept or a bad relationship stay where they are on the medication. The urgency of change fades away."

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