America is awash in antidepressants.
In March the Associated Press reported that the drinking water of at least 41 million Americans is contaminated with at times voluminous cocktails of prescription drugs. Many of these contaminants are psychiatric drugs. In Philadelphia, for example, a glass of tap water brings along with it trace elements of up to fifty-six pharmaceuticals and byproducts, including Prozac, Valium and Risperdal, a drug primarily used to treat schizophrenia.
Also in March, IMS Health, the leading provider of prescription drug utilization figures, reported that in 2007 a remarkable 233 million prescriptions for antidepressants were written for Americans, more than for any other class of medication. No wonder the drugs are ending up in the water. (By way of clarification: this does not mean that 233 million Americans are taking antidepressants. Individuals are being given multiple prescriptions and likely not always filling them. But it does mean that tens of millions of people are taking antidepressants–according to some studies, close to 10 percent of US adults.)
That Prozac and even stronger drugs would be in our water was predicted by the late novelist Walker Percy. His last work, The Thanatos Syndrome, was published in 1987, just before Prozac arrived on the scene. In the novel Dr. More, a Louisiana psychiatrist, notices that his patients have suddenly become vacant and indifferent. Their anxieties have been removed but so have their passions and foibles and eccentricities–all that, according to Percy, makes us human. Dr. More eventually uncovers a government-industrial conspiracy, in which “Heavy Sodium” is being put in the drinking water. The masterminds of the Heavy Sodium plot point to its impressive outcomes: reduced drug abuse and crime, improved “social welfare.” Unfortunately there are those pesky side effects–loss of language skills, sexual problems, child abuse, numbness…
But even Percy wouldn’t have predicted the staggering numbers reported recently. He was just writing about one Louisiana parish, not a national phenomenon. Which brings up the question: how did it happen that we are all drinking Heavy Sodium, in all its forms? How did Philadelphia get on Risperdal?
At the heart of the problem lies a confusion between illness and suffering. Psychiatric drugs can be lifesaving for the people they were originally developed and intended for–people with severe conditions, such as schizophrenia, bipolar disorder and major depression. But under pressure from brilliant drug marketing, managed care and the relentless expansion of psychiatric diagnosis in recent decades, treatments that are effective for serious mental illnesses have been generalized ever outward to far lesser conditions, and even to ordinary life problems and stresses. I’ve talked with many people who have said that they were prescribed antidepressants (now mainly prescribed by family doctors) because of financial and relationship problems–in effect, for “my marriage is awful disorder,” “can’t afford my SUV disorder” and “don’t like my boss disorder” (actual reasons for antidepressant use told to me by patients). These situations may be very painful, but are they mental illnesses? Nondrug approaches are often more effective for milder conditions and are typically overlooked. And as with Percy’s Heavy Sodium, the side effects of the antidepressants are greater than were first appreciated. In particular, getting on and getting off the drugs can prove very difficult for a significant number of patients.
By the end of The Thanatos Syndrome, Percy’s hero uncovers the conspiracy, the water is cleaned up and the people return to their quirky and difficult–but very much alive and human–selves. No such luck, it appears, in contemporary America, where we continue to ask the drugs to do what they were never intended for: to medicate and subdue the more troublesome aspects of the human condition.