Why are more women depressed? Is this a real epidemic – or the result of cynical marketing by drug giants? — (Daily Mail)

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 Daily Mail

By John Naish

Last updated September 2011

One in three of women polled had taken antidepressants during her lifetime

More women than ever are reaching for the happy pills, it was revealed last week. New research suggests there has been a massive increase in the number of women with depression.

Women are twice as likely to suffer from the illness than they were 40 years ago, and as many as one in seven will be affected by the condition at some point in their lives ­ more than double the number of men, according to a study published in the journal European Neuropsychopharmacology.

And the result of these soaring depression levels is becoming all too clear: ­a massive rise in prescriptions for antidepressant drugs.

Newly released figures from the Office for National Statistics show that more than four times as many prescriptions for drugs such as Prozac and Cipramil were dispensed in United Kingdom in 2009 than 18 years before.

Women are twice as likely to be prescribed antidepressants than men ­ around two-thirds of all NHS antidepressant drugs are prescribed to women. The scale of these increases, over a comparatively short period of time, is breathtaking. So what’s behind the rise?

The German researchers for the European study blame one factor: modern life. Professor Hans-Ulrich Wittchen, in charge of the research, says the pressure of trying to cope with having a family and pursuing a career is leaving women with a ‘tremendous burden’.

But is it really so simple? Go back 40 years and British women were hardly basking in leisure. They had grown up during the Blitz, suffered severe rationing, shortages and poverty wages. They were the victims of demoralisingly blatant sex discrimination and still had to haul in the coal.

Meanwhile, modern-day men are suffering unprecedented job losses, their role as the head of the family is disappearing and their lives are also getting more hectic and harried. But men’s depression rates have not climbed nearly so high.

In fact, one of the main reasons behind this astonishing rise in antidepressant use is that women are increasingly being parked on these powerful and potentially dangerous drugs for want of anything else to help them with the emotional distress that led them to visit their doctor.

This was echoed in a poll of 2,000 women released in June by the women’s campaign group Platform 51 (formerly the Young Women’s Christian Association, YWCA).

Women are twice as likely to be prescribed antidepressants than men

One in three of the women polled had taken antidepressants during her lifetime. More than half of these were not offered any alternatives to drugs. And a quarter were left on the drugs for more than a year without having their prescriptions reviewed.

This is despite the fact that guidelines from the health watchdog NICE say that ‘talking therapies’ such as cognitive behavioural therapy (CBT) should be the first-line therapy for patients with mild depression.

Treatment for patients who have moderate to severe depression should be a combination of talking therapy and antidepressants.

‘Women and girls don’t want to take these drugs for a long time and would prefer GPs to discuss with them why they are down in the first place,’ says Platform 51’s director of policy, Rebecca Gill. ‘They can feel no one is interested in their story.’

But many GPs say they feel forced to prescribe women antidepressants because it is difficult to organise alternative support such as psychotherapy.

Dr Peter Kandela, a former correspondent for The Lancet and a GP with a special interest in depression, says: ‘Theoretically, it would be better to give many of them counselling or CBT than antidepressants.

‘I would love to do it. But you have to fill in so many forms and contact so many people.’

Dr Kandela, who has a practice in Ashford, Middlesex, adds: ‘When the appointment finally comes, it is often too late to be of help.’ He says that arranging therapy can take three months.

‘This happened recently with a distressed patient. She gave up waiting and went to another doctor, who put her on antidepressants.’

The drugs carry the potential risk of serious side-effects, ranging from anxiety and loss of appetite and libido to convulsions and mania.

For this reason, the Royal College of General Practitioners advises that antidepressants be prescribed for only limited periods, up to a few months.

However, there is another factor affecting the judgment of hard-pressed doctors: women who are having emotional problems are far easier to spot than depressed men.

‘Men might not have their symptoms recognised so easily as women,’ says Bridget O’Connell, head of information at mental health charity Mind.

‘Evidence from our survey that compares 1,000 men and 1,000 women shows women may describe classic symptoms such as feeling down, tearful or anxious.

‘Men are more likely to act out their distress through drinking too much or being hostile and withdrawn, or they may have physical symptoms such as feeling nauseous or suffering from headaches.’

On top of that, there is the oft-quoted fact that men are much less likely than women to visit a doctor about emotional issues. This has traditionally been put down to the fact that men are too scared or incapable to describe their feelings of anxiety, depression or loneliness.

But a new study of nearly 2,000 children and adolescents has found a rather different answer ­ many males simply can’t be bothered with such thoughts.

‘When we asked young people how talking about their problems would make them feel, boys didn’t express angst or distress about discussing problems any more than girls,’ says Amanda Rose, a psychology professor at the University of Missouri, who was in charge of the research.

‘Instead, the boys’ responses suggest they just don’t see talking about problems to be particularly useful. It would make them feel as if they were wasting time.’

Antidepressants carry the potential risk of serious side-effects, ranging from anxiety and loss of appetite and libido to convulsions and mania

That still leaves us with the question: Are women really more depressed than ever?

Professor David Healey, director of psychological medicine at Cardiff University, thinks this is unlikely. Instead, he says, the leap in prescriptions for antidepressants may be seen as a triumph for drug company sales departments.

Professor Healey, the author of Let Them Eat Prozac, has argued that antidepressants are today’s ‘mother’s little helpers’ ­ the new incarnation of tranquillising drugs such as Valium.

‘In the Sixties and through to the end of the Eighties, companies marketed tranquillisers and had to persuade people they were anxious,’ he says.

When Valium-type drugs fell from favour in the Eighties because of their addictiveness, drug companies developed a different class of drugs: antidepressants.

‘In order to market antidepressants you have to persuade people they are depressed,’ says Professor Healey.

‘It is a case of labelling. People are as stressed as they were. The reason they view the problem as depression is down to marketing.’

Drug companies certainly do continue to push antidepressants on to women ­ even if the women are not suffering from a mood disorder.

Pharmaceutical firms are always keen to find new uses for their existing drugs because they do not have to take them through another highly expensive round of trials to prove they are considered safe enough for human consumption.

Furthermore, it may well be that so many women take antidepressants that it seems normal and acceptable to be given them ­ for whatever use.

For example, an American study in June declared that the antidepressant drug escitalopram can ease hot flushes in healthy, non-depressed women.

The study concluded that 55 per cent of women who took the drug, which acts on the brain’s feelgood chemical serotonin, had at least 50 per cent fewer hot flushes. But since when were hot flushes a problem to be medicalised and drugged?

Antidepressants have also frequently been prescribed to women with menstrual problems. The practice has been criticised by Claudine Domoney, a consultant gynaecologist at Chelsea and Westminster Hospital in London.

‘Doctors should always explore other avenues before handing out antidepressants for premenstrual syndrome.

‘It shouldn’t be first-line treatment,’ she says. ‘Why give a young woman a drug with potentially serious side-effects when it might not be necessary?’

Meanwhile, there is a dearth of well-funded research or support for alternative forms of treatment for women suffering from emotional problems.

Research by five mental health charities found depressed patients were having to wait for six to 18 months for an appointment with an NHS counsellor, with many being forced to go private.

Other alternatives which show promise in small-scale trials include acupuncture and light therapy.

A study of 27 depressed mothers-to-be in the Journal of Clinical Psychiatry in April found that after five weeks of full- spectrum light therapy, of the type given to people with seasonal affective disorder, 13 of the women had at least a 50 per cent improvement in their symptoms and 11 were no longer depressed.

Clearly, we do need alternative forms of support and treatment for women who experience emotional problems.

It may be true that life is more hurried, but it is also true that women have always experienced mood problems as part of the natural highs and lows of life.

In the past, they would have been supported by large, close families. Nowadays, they may need to turn to their family doctors for help.

But the answer, surely, cannot be to prescribe ever more mind-numbing antidepressant pills.