New research shows Americans have become increasingly accepting of psychiatric medications such as antidepressants, the use of which is on the rise.

For some people, the drugs are essential. But others appear willing to use antidepressants for reasons that experts say may be unwise.

Antidepressants are the most routinely prescribed class of drugs in the United States, according to a study out Monday in the Archives of General Psychiatry, which found that the rate of their use by people ages 6 and older nearly doubled from 1996 to 2005.

While the authors say the increase is probably due to a cluster of factors -- such as more antidepressant options on the market, their expanded use to treat conditions other than depression, and direct-to-consumer advertising -- their changing reputation in the public eye has most likely also played a part, says psychiatrist Ramin Mojtabai, an associate professor in the department of mental health at the Johns Hopkins Bloomberg School of Public Health, who was not involved in the new study.

"While there's good news that people are more willing to take medications when they need [them], when there's an indication, they are also more willing to take them when there is no evidence-based reason to," says Mojtabai, whose study of Americans' opinions on psychiatric medications appears in the current issue of Psychiatric Services.

Indeed, in comparing the opinions of 1,387 survey respondents in 1998 with those of 1,437 respondents in 2006, he found that people appear increasingly willing to takeantidepressants and other psychiatric medications for symptoms of depression and panic attacks but also for "very common distressing experiences" that "are not psychiatric disorders"--like everyday stress and interpersonal problems.

Although the survey only asked questions about hypothetical situations, not questions about actual behavior, Mojtabai says his findings raise questions about whether the public understands for whom antidepressants are truly effective.

"Medications are not always safe," he says. "There are problems with taking [them] when there's no real indication."

Antidepressants can indeed be lifesaving when clinically appropriate, he says, but his findings suggest that confusion may abound about what that means.

Here are three not-so-great reasons to consider an antidepressant:

1. To improve relationships with family and friends

When asked about the benefits of psychiatric medications, more people surveyed in 2006 than in 1998 said they'd be willing to take them to ease trouble in their personal life, and more people thought the meds could "make things easier in relations with family and friends," Mojtabai found.

But unless a psychiatric disorder is at the root of one's relationship woes, there's no reason to think that antidepressants would help, says Mojtabai -- though people taking antidepressants for depression, which often leads to social withdrawal and isolation, may notice improvements in their interpersonal relationships as their underlying condition improves.

2. To raise self-esteem

More respondents in the later survey thought psychiatric medications would "help people feel better about themselves," Mojtabai found. Again, he says: "We know that if a person doesn't feel bad about themselves because of a psychiatric disorder, then there's really not much evidence that [antidepressants] are helpful."

3. To deal with day-to-day stress

By 2006, more people also believed that psychiatric medications "help people to deal with day-to-day stresses" and were willing to take them to cope with those, Mojtabai found.

Yet, unless there's some underlying psychiatric illness, "there's not much evidence that these medications help people deal with day-to-day stresses" such as problems at the office, he says.

Mark Olfson, a professor of clinical psychiatry at Columbia University and lead author of the Archives of General Psychiatry study, believes that those at risk for being inappropriately prescribed antidepressants are healthy people who function well day to day but develop some anxiety or depressed mood directly after a stressful event such as a divorce or the loss of a job.

"It's natural for people during those periods to experience times when they feel down or blue or feel isolated," says Olfson, "but that has a distinctly different quality to it than depressive disorders."

Olfson and Mojtabai agree that antidepressants are an option for people who have severe and persistent depressive symptoms -- feelings of sadness, hopelessness, worthlessness, lack of interest in activities, trouble eating or sleeping, to name a few -- that endure over a couple of weeks.

"We know from clinical trials that antidepressant medications are beneficial for mood disorders, most importantly for major depression," and for the treatment of several anxiety disorders, says Mojtabai.

The bottom line, he says, is that antidepressants are useful in certain defined circumstances but aren't the solution to every case of the blues or stress attack; in fact, they may even be harmful.

Though generally safe, antidepressants have been associated with side effects including sleep problems, sexual problems, weight gain, and suicide risk in youth, Mojtabai adds.

If people are having difficulty managing stress or easing interpersonal problems, there are other options, such as psychotherapy, that mental-health professionals can offer, he says.

 

 

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