Medications/Prescription Trends

The use of antidepressant medications has demonstrated success in working to calm neurotransmitters (brain chemicals such as norepinephrine and serotonin), while other antidepressant medications focus on dopamine, which is responsible for controlling mood instabilities. Combined treatment of psychotherapy and medication is the usual and preferred treatment of choice for depression.89

While antidepressants have been shown to be helpful, there is some concern they are being overused. The U.S. Centers for Disease Control and Prevention (CDC) reports eleven percent of Americans 12+ used antidepressants in the US during 2005–2008. About one-third of adult Americans use antidepressant medications for severe depressive conditions. In a recent cross-sectional survey study, use of prescription medications that have depression as a potential adverse effect was common. Use of multiple medications was associated with greater likelihood of concurrent depression.90 A 2007 study surveyed 8,098 Americans, from which it was reported 25% were over diagnosed for depression, regardless of medical intervention.90 The number of antidepressants prescribed to patients in England has doubled in a decade, official figures show.91

In a 2002 survey conducted in France, it was reported 3.5% of the people had been prescribed antidepressants, in comparison to a 1.7% prescription rate in a 1992 finding. The results further indicated the antidepressants were not being used for depressive disorder symptoms, and the prescriptions were not in accordance with specific guidelines identified to treat depressive illnesses.92 In British Columbia during 1996–2004, the use of antidepressants increased from 3.4% to 7.2%.93 In the Netherlands during 1992–2001, an increased rate of prescriptions for antidepressants was recorded along with increased periods of treatment necessary to treat depressive illnesses.94

The Organization for Economic Cooperation and Development (OECD) looked at antidepressant use in 25 countries and found that in every single country reviewed by the OECD, antidepressant use was on the rise.95

According to the National Institute of Mental Health, the most popular antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Other widely prescribed antidepressants are serotonin and norepinephrine reuptake inhibitors, or SNRIs. Bupropion, a third type of antidepressant, is also used to treat seasonal affective disorder (and to help with smoking cessation).96

To fully understand how antidepressants work and the specific classifications of each is significant when trying to avoid side effects, negative interactions from other prescriptions, over-the-counter medications, herbal nutriceuticals, and nicotine replacements. The awareness of coexisting medical conditions, recognition of clinical signs and symptoms, and a history of any depressive disorders and/or treatments aide in determining the best antidepressant based on the individual’s disorder.97 Regarding St. John's wort, a botanical product used widely to treat depression, be aware that the FDA has not approved its use as an over-the-counter or prescription medicine for depression. There are concerns about its safety, and it should not be combined with a prescription antidepressant.97

There are numerous classifications of antidepressant medications with the latest and most commonly used antidepressants falling into two classifications: selective serotonin reuptake inhibitors (SSRI) and serotonin and norephinephrine reuptake inhibitors (SNRI).96 SSRIs include: fluoxetine (Prozac); citalopram (Celexa); sertraline (Zoloft); paroxetine (Paxil); and escitalopram (Lexapro). Examples of SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta).96

Fewer side effects have been reported from SSRIs and SNRIs than tricyclics and tetracyclics, older classifications of antidepressants such as (Elavil) and (Pamelor) and monoamine oxidase inhibitors (MAOI) such as (Nardil) and (Marphan). Not all medications will prove effective and some may produce intolerable side effects; consequently, physicians will alter between categories of antidepressants, or prescribe antipsychotic medications that potentially improve the efficacy of the antidepressant.96

Those taking MAOIs require a thorough understanding of the medication’s ability to interact negatively with certain foods; particularly the chemical tyramine, found in wines, pickles and many cheeses, and over-the-counter (OTC) medications such as decongestants.98 For example, Wellbutrin, a commonly prescribed antidepressant used to treat SAD symptoms, should not be taken while using Zyban or other nicotine replacement alternatives intended for use in smoking cessation protocols. Wellbutrin is not advised for those with eating disorders or in combination with a MAOI; negative interactions can increase blood pressure and potential stroke conditions can develop.99

It is vitally important that all health care professionals understand the potentially fatal interactions between antidepressants and prescription medications. The Food and Drug Administration (FDA) in 2005 established “black box” warning labels on all antidepressant medications; alerting patients and health care professionals to the increased risk of suicide and suicidal attempts in children and adolescents taking such medications. The FDA in 2007 extended the “black box” warning to include young adults through age 24. The “black box” warning represents the gravest of warnings on any prescription labeling. Close monitoring is necessary for those patients taking antidepressants; any unusual behaviors, worsening depression or suicidal behaviors should be reported to their physician immediately.100