This article was previously published June 20, 2019, and has been updated with new information.<\/strong><\/p>\n In 2017 the World Health Organization declared that depression was the leading cause of ill health and disability worldwide, and had increased 18% between 2005 and 2015.1<\/span><\/sup> In the U.S., an estimated 17.3 million American adults, or 7.1% of the adult population, experienced at least one major depressive episode in 2017.2<\/span><\/sup> The highest rates were reported among those aged between 18 and 25.3<\/span><\/sup><\/p>\n In 2021 those numbers changed drastically in the wake of the COVID-19 pandemic, with approximately 280 million people worldwide suffering from depression.4<\/span><\/sup> In the U.S. in the early months of the pandemic, depression tripled from 8.5% to 27.8%, and then skyrocketed to 32.8% in 2021.5<\/span><\/sup> It dropped to 22% in the period between March 30, 2021, and April 11, 2022.6<\/span><\/sup><\/p>\n Although the confinement of quarantines and the restrictiveness of mandatory masking and vaccination, coupled with job and income losses, admittedly played a part in the sharp rise in depression during the pandemic, questions still abound over whether people are being inappropriately diagnosed, and even more importantly, what the best treatment might be.<\/p>\n With regard to treatment, my review will focus primarily on exercise which, rather overwhelmingly, appears to have a solid scientific basis of support.<\/p>\n According to one 2013 study,7<\/span><\/sup> major depression may be vastly overdiagnosed and overtreated. When Dr. Ramin Mojtabai, associate professor at the Johns Hopkins Bloomberg School of Public Health, evaluated the diagnostics of 5,639 participants with clinician-identified depression, he found only 38.4% of them actually met the DSM-4 criteria for a major depressive episode (MDE).8<\/span><\/sup> Among seniors over the age of 65, only 14.3% met the criteria. Furthermore:9<\/span><\/sup><\/p>\n “[P]articipants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications.”<\/em><\/p><\/blockquote>\n Mojtabai told The New York Times:10<\/span><\/sup><\/p>\n “It’s not only that physicians are prescribing more, the population is demanding more. Feelings of sadness, the stresses of daily life and relationship problems can all cause feelings of upset or sadness that may be passing and not last long. But Americans have become more and more willing to use medication to address them.”<\/em><\/p><\/blockquote>\n An earlier 2009 meta-analysis11<\/span><\/sup> of 41 studies that assessed the accuracy of diagnoses of depression by general practitioners found “GPs correctly identified depression in 47.3% of cases.” So, over the years, it appears overdiagnosis is becoming more prevalent and not less.<\/p>\n According to this review, findings suggest “that for every 100 unselected cases seen in primary care, there are more false positives (n=15) than either missed (n=10) or identified cases (n=10),” and that “Accuracy was improved with prospective examination over an extended period (three to 12 months) rather than relying on a one-off assessment or case-note records.”<\/p>\n While we must not downplay the seriousness of major depression, we must also not lose sight of the fact that the experience of a wide range of human emotions is normal and healthy.<\/p>\n In a controversial move, the bereavement exclusion12<\/span><\/sup> \u2014 where “clinicians were advised to refrain from diagnosing major depression in individuals within the first two months following the death of a loved one” \u2014 which was included in DSM-4, was removed in DSM-5 in 2013. As noted in the paper, “The bereavement exclusion and DSM-5: An update and commentary:”13<\/span><\/sup><\/p>\n “The removal of the bereavement exclusion in the diagnosis of major depression was perhaps the most controversial change from DSM-IV to DSM-5. Critics have argued that removal of the bereavement exclusion will “medicalize” ordinary grief and encourage over-prescription of antidepressants.<\/em><\/p><\/blockquote>\n Supporters of the DSM-5’s decision argue that there is no clinical or scientific basis for ‘excluding’ patients from a diagnosis of major depression simply because the condition occurs shortly after the death of a loved one (bereavement). Though bereavement-related grief and major depression share some features, they are distinct and distinguishable conditions.<\/em><\/p><\/blockquote>\n Bereavement does not ‘immunize’ the patient against a major depressive episode, and is in fact a common precipitant of clinical depression. Recognizing major depression in the context of recent bereavement takes careful clinical judgment, and by no means implies that antidepressant treatment is warranted.<\/em><\/p><\/blockquote>\n But given the serious risks of unrecognized major depression \u2014 including suicide \u2014 eliminating the bereavement exclusion from DSM-5 was, on balance, a reasonable decision.”<\/em><\/p><\/blockquote>\n The problem with taking an antidepressant to maneuver through difficult emotional territory is that many end up taking them long-term, and many find they can’t get off them without suffering debilitating withdrawal symptoms. As noted by Pharmacy Today in April 2018:14<\/span><\/sup><\/p>\n “Initially, the drugs were cleared for short-term use; but even today, with millions of long-term users, there is little data about their effects on individuals who take them for years…<\/em><\/p><\/blockquote>\n And yet, it is not clear that everyone who is taking an open-ended prescription should stop. Most physicians agree that a subset of users may benefit from a lifetime prescription, though they disagree on the size of that group.”<\/em><\/p><\/blockquote>\n According to a 2017 study,15<\/span><\/sup> 1 in 6 Americans between the ages of 18 and 85 were on psychiatric drugs, most of them antidepressants, and 84.3% reported long-term use (three years or more). Out of 242 million U.S. adults, 12% were found to have filled one or more prescriptions for an antidepressant, specifically, in 2013. In 2021 the U.S. Centers for Disease Control and Prevention reported that 1 in 5 Americans is now on mental health prescription drugs.16<\/span><\/sup><\/p>\n “Mental health doctors in South Carolina say they have been treating two main types of mental health disorders during the pandemic: situational depression and neuropsychiatric sequelae,” WRXF reported. What’s worse, according to WXRF TV in Horry County, South Carolina, a record number of children are also experiencing mental health issues.<\/p>\n No matter what your diagnosis is, research does show there may be a price to pay for the long-term use of antidepressants. For example, one 2015 study17<\/span>,<\/sup>18<\/span><\/sup> found that, compared to perimenopausal women treated with H2 antagonists or proton pump inhibitors (indigestion drugs), selective serotonin reuptake inhibitors (SSRI, a class of antidepressants) raised bone fracture rates by 76% in the first year of use.<\/p>\n After two years of treatment, the fracture rate was 73% higher. In 2017, Canadian researchers warned SSRIs might increase patients’ risk of cardiovascular events by 14% and all-cause mortality by 33%,19<\/span><\/sup> likely due to their anticlotting properties. As noted in the abstract:20<\/span><\/sup><\/p>\n “We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples \u2026 Seventeen studies met our search criteria. Sample type consistently moderated health risks.<\/em><\/p><\/blockquote>\n In general-population samples, AD [antidepressant] use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks.<\/em><\/p><\/blockquote>\n AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic Ads \u2026 The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.”<\/em><\/p><\/blockquote>\n Research21<\/span>,<\/sup>22<\/span><\/sup> published in 2009 also strengthened the evidence indicating the low serotonin idea is incorrect, finding strong indications that depression actually begins further up in the chain of events in the brain. Essentially, SSRIs focus on an effect of depression, not the cause.<\/p>\n As noted by investigative health journalist Robert Whitaker,23<\/span>,<\/sup>24<\/span><\/sup> as early as the 1980s the National Institutes of Mental Health investigated whether or not depressed individuals had low serotonin.<\/p>\n At that time, they concluded there was no evidence that there is anything wrong in the serotonergic system of depressed patients. Drug companies kept running with the low serotonin theory, though, as it justified the aggressive use of antidepressants to correct this alleged “imbalance.”<\/p>\n Most interesting is that diagnoses of mental illness seemed to suddenly spike the same year that the Selective Serotonin Reuptake Inhibitor Prozac debuted. In a paper he wrote on the topic, Whitaker said:25<\/span><\/sup><\/p>\n “Prozac was touted as the first of a second generation of psychiatric medications said to be so much better than the old. Prozac and the other SSRIs the tricyclics, while the atypical antipsychotics (Risperidone, Zyprexa, etc.) replaced Thorazine and the other standard neoroleptics.<\/em><\/p><\/blockquote>\n The combined sales of antidepressants and antipsychotics jumped from around $500 million in 1986 to nearly $20 billion in 2004 (from September 2003 to August 2004), a 40-fold increase \u2026 [and] the number of disabled mentally ill in the United States \u2026 increased from 3.331 million people to 5.726 million \u2026 [equal to] 410 people newly disabled by mental illness every day.”<\/em><\/p><\/blockquote>\nMany Are Needlessly Taking Antidepressants<\/h2>\n
There’s a Fine Line Between Depression and Normal<\/h2>\n
1 in 5 Americans Is on a Psychiatric Drug<\/h2>\n
Long-term Use Places Life and Limb at Risk<\/h2>\n
Low Serotonin Theory Demolished, but Antidepressants Go On<\/h2>\n