Top US psychiatric pharmaceuticals, 2009 edition

IMS, a market research firm, has tallied up the most popular psychiatric prescriptions in the USA for 2009. Notes Gary Price, "The list itself sees Xanax remain at #1 with over 44 million superscription written. Lexapro is at #2 while Ativan is at #3. Several new medicines debuted on the list."

Top 25 Psychiatric Prescriptions for 2009 (Thanks, Gary!)

Previously:

I write books. My latest is a YA science fiction novel called Homeland (it's the sequel to Little Brother). More books: Rapture of the Nerds (a novel, with Charlie Stross); With a Little Help (short stories); and The Great Big Beautiful Tomorrow (novella and nonfic). I speak all over the place and I tweet and tumble, too.

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Mark Gordon

There are non-psychiatric indications for some of these. Seizure control was mentioned already. Valium is used in preparation for certain surgical procedures; it’s unclear to me whether that’s included in these figures.
Robert Aguirre

Xanax is middle class pot. People take it somewhat recreationally to take the edge off, but they won’t get arrested and they can get it when they buy groceries. Plus, if they’re insurance is good enough it’s conceivable cheaper.

Which of course isn’t to suggest that there aren’t people with debilitating anxiety that would be dysfunctional without it. I just wonder about the relative proportions.
MiaR

44 million is the number of prescriptions for Xanax, not necessarily the number of people on Xanax. You don’t just get refill after refill of this stuff (well, at least if you have a good doctor you don’t). My doctor gives me a new prescription each time. So, if they are just counting the number of prescriptions, about 4 of those are me. I’m sure there are others who are the same.
Anonymous

Does anyone know the actual rate of clinical depression for the US? Or the rate of anxiety based conditions for which medication is the prescribed course of treatment?

I have to think that these numbers are showing a prescription rate 3x to 4x the actual rate for recommended treatment.

These numbers are not surprising, but they are frustrating as hell. Big-pharma has so inured itself into the matrix of our lives. I know a person who used to work for a major Pharm and was livid when regulations were proposed to limit the amount of money Pharma could spend plying doctors with dinners and vacations. They said “This business is all about the relationships”.

No, this business is supposed to be all about helping the patients, and 44 million xanax users seems glaringly out of line with that mission.
Anonymous

Also, and absolutely fascinating book on rethinking our approach to anxiety and depression (of the non-David Foster Wallace yes you should absolutely be on medication variety) is Against Happiness by Eric G. Wilson.
Anonymous

I was on nardil from 1980 to 1991. It didn’t really help the underlying cause of my depression/anxiety, just made me fat and manic. I guess I interpreted that as being “cured” because I stayed on the nardil (avoiding wine and cheese of course). I tried being “med free” from ’91 to ’92, but simply could not do it. The old depression/anxiety returned with a vengeance. In 1992, my primary care doc put me on paxil, which I stayed on until 2009. Like the nardil, it made me manic, which I again interpreted as being cured. I was still depressed. In ’97, I had a sleep study for apnea. They could see by my brain waves that I had “alpha intrusions”… abnormal sleep architecture. The paxil was making the quality of my sleep worse, which made my symptoms worse.
In my opinion, most of the problems that lead folks to seek pharmaceutical relief can be traced back to abnormal sleep architecture. If you’re not getting quality sleep. all stages, uninterrupted, then you will have symptoms. Is there a medication that can fix that? Not that I know of. Xanax suppresses slow wave, stage 4 sleep. So do most sleeping pills.
mister-o

Anti-depressants that experienced a decline in usage from 05 to 09:
Zoloft
Prozac
Effexor
Celexa
Wellbutrin

Anti-depressants that were released in a generic form between 05 and 09 (inclusive):
Zoloft
Effexor
Celexa
Wellbutrin

Do the math.
- maryr
  
  Additionally, bupropion (at 14) is the generic of Welbutrin (at 22). And Lexapro (at 2) is one enantiomer of Celexa (at 17) (chemicals essentially have handedness, usually only the left-handed is biologically active. Lexapro (escitalopram) is only the left-handed half of Celexa (citalopram. Following the link on the list, you’ll also find that “amphetamine salts” (at 11) is the generic of Adderall (the extended release of which is 21)
  
  What I’m trying to say is that if you condense brand names and releases a bit, you get
  
  1. zoloft (44,029,000)
  2. Lexapro + Celexa (34,913,000)
  3. ativan (25,868,000)
  4. zoloft (19,500,000)
  5. prozac (19,499,000)
  6. Desyrel (18,873,000)
  7. Cymbalta (16,626,000)
  8. Adderall + Adderall XR (16,049,000)
  9. Seroquel (15,814,000)
  10. Effexor XR (14,992,000)
  11. Valium (14,009,000)
  12. Bupropion + Welbutrin XL (12,002,000)
  
  Anything else that’s essentially a name brand and a generic?
aelfscine

The thing that I think is a shame is that none of these drugs actually solve anything. Depression and anxiety don’t just happen randomly, there’s a cause to them. And if you’re just popping pills so that you don’t notice the depression any more, you’re doing nothing to address the cause of the problem. The problem is still there, unfixed – you’re just ignoring it. So now the drugs become essential in two ways – first, just straight-up addiction, and second, if you ever stop taking them, the thing that was making you depressed in the first place is still there, and has probably gotten worse due to your inattention. Your sucky job that works you double what it should is still doing it, because all the time you were drugged up it never bothered you. Your husband has a girl on the side because you work 80 hours a week? Yep, she’s still there too.

Just think, if you’d quit your job and gotten a divorce, you might not have needed the drugs in the first place!
- Rindan
  
  Depression and anxiety don’t just happen randomly, there’s a cause to them. And if you’re just popping pills so that you don’t notice the depression any more, you’re doing nothing to address the cause of the problem.
  
  …unless of course the root cause of your depression is just that your brain chemistry is fucked up. You brain, like any piece of your body, can fail. You stomach can get indigestion, your immune system can flip its shit and attack you just because you got in close proximity to a cat, the list is basically endless. You brainz are not the magic exception.
  
  When I get depressed, it is because something very horrible just happened. Nothing short of someone close to me dying can tip me into depression, and even then, I rebound in a couple of days and return to my default “it could be worse, let’s be happy to be alive!” self. When it comes to depression, I won the genetic lottery (at least in depression, I certainly lost when it comes to allergies and dashing good looks). When I am sad, something is horribly wrong, doom is upon us, and you would have to be utterly insane to not see that sadness is the right answer.
  
  My ex-girlfriend on the other hand lost the genetic lottery when it comes to happiness. Situations that wouldn’t merit a second thought in my mind caused her worry and true heartache. Where my default emotion is happiness just on the edge of euphoria, hers was anxiety bordering on depression. Everything in life could be perfect, all her life goals met, she could be surrounded by great friends, and one minute she could be happy, and the next tip over into a depression black enough that I could only achieve it by murdering my entire family.
  
  My point is that people have different brain chemistry/structure/whatever. Some people are stuck at a miserable default level. It isn’t that their lives suck more than anyone else, or that their lives are awesome and they just don’t realize it. Most folks who are depressed for no reason realize that their depression is dumb and they really should cut that shit out. The brain just doesn’t agree. So, we use chemical to try and kludge the brain into a more tolerable default level.
  
  Sometimes the answer to depression is to fix your shit. You are sad because your life sucks and you should cut that shit out and do something that makes you happy. Sometimes though, you are sad because you brain is merrily pumping the “be sad” chemicals for the same reason why my immune system is pumping out “kill!” chemicals at pollen… which is to say no good reason.
Silent_Guru

“It is by will alone I set my mind in motion. It is by the juice of sapho that thoughts acquire speed, the lips acquire stains, the stains become a warning. It is by will alone I set my mind in motion.”
nutbastard

yeah, but god forbid anyone take LSD once and figure out WTF they’re so anxious about…
- mister-o
  
  Indeed. If I took LSD I’d figure out why I’m so anxious and then I could OH GOD THE SPIDERS ARE EVERYWHERE THEY’RE CRAWLING ON THE WALLS GET THEM OFF GET THEM OFF!
  
  On a more serious anecdotal note, I know plenty of people who have ingested a substantial quantity of hallucinogens over the course of their life, and, obviously, plenty who have not. Those in the former category, while avowing more insight into their issues, also avow much more insight into what’s “wrong” with other people and how much hallucinogens could “help” with that. For what it’s worth, they also tend, in my observation, to be more anxious and depressive on the whole. So it’s not clear that their insight, even if genuine, translates to better life skills or subjective well being. I’m deliberately not asserting the existence of or a direction of causality. I’m also aware that these observations are only my experience, and are potentially due to availability (or other) bias. This is also not a comment on the legality of hallucinogens, nor on the normative status of actual or potential legality.
  - nutbastard
    
    LSD was instrumental in me sorting out some circumstantial causes of depression – i wouldn’t recommend it for someone in the throws of the manic flavor – and no other experience has ever provided anything close to the growth and yes, personal insight that those experiences have.
    
    both my parents are manic depressive, as am I (though less and less as i age, probably due to more balanced hormones as well as being cognizant of the difference between manic and normal depression, and having come up with methods for coping with it).
    
    in my case it’s purely genetic. there are specific qualities of my manic depression that are unmistakable, and allow me to make the distinction. one of the terrifying aspects of it early on is not knowing wtf is making you feel the way you do. you’ll catalog your life and feel pretty good about all parts of it, and yet you’ll just be utterly destroyed inside, unable to pin any sort of cause (and thus formulate a plan to tackle that cause) on it. there’s generally an overwhelming sense that you’re never going to get out of it, and that’s only amplified by realizing how helpless you are to do anything about it – there’s no shit job or cheating spouse or anything external to work on. the closest thing i could compare it to would be if you were forced to watch horrible things being done to someone you love, unable to do anything about it – the situation is horrible as is, but the helplessness, the inability to act makes it even worse.
    
    it’s crippling, and if a pill can get you through the days until it subsides, then for gods sake, take the pill.
    - mister-o
      
      Thanks for sharing your experience. It’s important to get that sort of thing out in the open so that people without that kind of experience can become more aware of what it’s like and how powerless one can really be while in the throes of mental illness.
      
      For what it’s worth, I’ve been exactly there. Without going into too much detail, 2009 was one of the worst if not the worst year of mental illness that I have ever had. I tried many, many different medicines as monotherapies and in polypharmacy. I’m on day 87 now of being free of psychopharmaceuticals, and I can’t remember having ever felt better. (For completeness: I’ve also been in bi-weekly psychotherapy for > 6 months, too.) I haven’t felt a day that I would describe as coming close to seriously depressive since March 6th, and that was due to a bad hangover! Before that, and not caused by substances, it was Feb 22. The varieties and differences in peoples’ experience and what helps them are truly vast. For me, pills made me more sick (mood stabilizers, anti-depressants of various kinds, anti-psychotics – all bad). For emphasis: for me.
      
      I’ll repeat something you said, also for emphasis, because it is spot on and people need to hear it.
      
      Mental illness is crippling, and if a pill can get you through the days until it subsides, then for God’s sake, take the pill. Taking pills is not weakness. Going into therapy is not weakness. (Neither is a guarantee.) Stop if either makes you feel worse, but try something else. Keep trying. Keep going. Get help.
cmza

Ativan (and diazepam) is also used for seizure control.

What is a “superscription”?
- Suds
  
  I don’t know, and it’s FREAKING me out! *gulps down a handful of Xana-Lofta-Pro’s* Ahhh, That’s better.
- Michael Smith
  
  “Ativan (and diazepam) is also used for seizure control.”
  
  Yeah I take tegretol for siezure control but it is also a mood stabiliser. Mind you there have been a few situations when I was starting out on this drug where somebody played a prank by grabbing me from behind and they caught a face full of chair or whatever was handy. So while I generally agree that it stabilises mood I also think it causes race conditions which can lead to poor judgement on short time scales.
  
  “What is a “superscription”?”
  
  I think they mean prescription.
- BookGuy
  
  A superscription is when the doctor prescribes the medication, and the pharmacist physically throws handfuls of it into your mouth.
  
  @dequeued
  
  I hear ya. I took Klonopin for several years to deal with an otherwise intractable panic disorder, and when I stopped taking it, it HURT. It took me a solid 9 months of weaning off and near constant withdrawal symptoms, and it aged me. I went from still passable as a college student to someone who was clearly in their late 30s, even though I was still in my 20s. It’s a tricky situation, though. The Klonopin was very necessary at the time it was prescribed. I couldn’t function otherwise. But the stopping…not so nice.
Anonymous

Nitpicking, but I noticed a couple commentators comparing the numbers on the chart to the population of the US, so it should be pointed out that this chart is measuring the number of “prescriptions.” Unless the vast majority of people on these meds are getting one prescription a year, than the numbers reported are a multiple of the number of people on the meds.
thequickbrownfox

7 years on Zoloft and it only takes the edge off the anxiety, switched to Prozac recently and the side-effects are intolerable (insomnia, skin rashes, dehydration)

Now on Aropax, but I have to wean off Prozac with a 14 day cold turkey regime before I can actually take them.
hassan-i-sabbah

milgrim asks “Where is “RIZE”?”
Anonymous

I can’t wait ’til all this stuff is illegal. The side-effects for this stuff are horrendous. Some of them have less than placebo effect effectiveness. Withdrawal from this stuff can take years. Maybe the FDA will be reformed in the coming years.

p.s. LOL: the CAPTCHA phrase to enter this message is: “massive rehabs” — how totally spot-on!
phisrow

Top US Psychiatric Pharmaceuticals, 1809 edition:
1. Ethyl Alcohol
2. Tobacco
3. Smelling salts
4. Opiate-containing Patent medicine(generic)
5. The Water cure.
weendex

I added up their top 25 list, not including risperdal, and the total was 302 Million prescriptions.

That is approximately 1 prescription per person in the US.

I don’t know how often these prescriptions are refilled, as apparently I am one of the rare few who doesn’t need psychiatric help, but this is a staggering number. wtf society?
- Daedalus
  
  “wtf society?”
  
  I’m in your boat, weendex. I think we’ve got some core social problems that are difficult for us to see, but that either lead to immense fear and depression in otherwise normal people, or lead to over-diagnosis of such things. I’m more in favor of the former.
  
  Y’know, tea party people, being typically poor and culturally rather mistrustful of psychiatry, probably don’t have widespread access to a lot of these mood stabilizers…wonder if we’d all be wahoos if it wasn’t for drugs…
  - jacques45
    
    Not that I agree with them at all, but remember that the tea protesters are actually better well-off than the average. Can’t answer to the part about the mistrust of psychiatry though, I thought that was the scientologists.
    
    Source for the demographics: http://www.nytimes.com/2010/04/15/us/politics/15poll.html?ref=politics
- maryr
  
  @weendex – Don’t discount the possibility that people have more than one prescription. I, for one, take two of the drugs listed here, so that should account for your abstention at least.
  
  @mister-o – I don’t disagree that therapy and medication should be paired when possible, but @Ignatz has a point as well. If you’re uninsured, a $100 weekly 50 minute hour comes to $400, which buys a lot of generic Welbutrin and is still more expensive than the name brand. If you have a heart condition, you’re best served seeing a specialist regularly for checkups, but isn’t taking an choloesterol lowering drug in the meantime better than nothing?
  - mister-o
    
    maryr – First, nice work on the condensed list. Quite revealing stuff.
    
    Second, yes, I considered posting again to reply specifically to the point about insurance in the individual cases. If you’re uninsured, therapy is not really a reasonable option – but also ask yourself how much Abilify you can buy with $400 (sans insurance, making less than $20K/yr before taxes – I’ve been there).
    
    Third, what I was trying to highlight, in an oblique way, was that the post I was responding to was using “cheaper” and “easier” in a patient-centric way, the facts of the matter – that newer, non-generics seem to come into fashion while generics fall out; that medication is actively marketed as being “for life”; and that psychotherapy has long-term, post-treatment dividends – strongly suggest to me that we also need to be talking about what is “cheaper” and “easier” for society as a whole, and in particular that we need to situate that discussion into a broader context of social safety nets.
nutbastard

“Depression and anxiety don’t just happen randomly, there’s a cause to them.”

Manic depressives everywhere would like to dispute that. Lots of times the best solution to a manic episode is to just wait it out. it can be days, weeks, months even. in the mean time, it kind of helps if you’re able to function.

as someone who obviously believes that depression is purely environmental, you likely have no clue how much worse depression caused by radical chemical imbalance can be compared to ‘normal’ depression, ie being depressed ‘about’ something.

i’ve never taken pharmaceuticals for depression for fear of mucking things up even more and it’s always worked out in the long run, but there are legitimate uses for these things, and the issue of depression is not nearly so black and white as you make it out to be. i’ve had people in my life die, devastating financial situations, betrayals, shitty jobs etc that made me depressed. none of them even came *close* to the times i was depressed for no reason at all.
- mister-o
  
  “Depression and anxiety don’t just happen randomly, there’s a cause to them.”
  
  Note the distinction between a particular episode of depression being caused by (a) specific environmental factor(s), and the depressive disorder itself being caused by (a) specific environmental factor(s). Not that anyone is in a position to evaluate the latter with any specificity or reliability.
Ignatz

Another thing to consider is that medication is cheaper and easier for the user than talk therapies. They’re about equally effective in treating anxiety and depression, but not many of us can spend an hour a week with a therapist. I’m also more likely to get coverage for a bottle of pills than for years of therapy. I’ve had to terminate therapy various times because my insurance wouldn’t cover the entire cost.
- mister-o
  
  With the disclaimer that I don’t discount the efficacy and necessity of medications in a variety of situations, psychopharmaceutical medications do not, to my knowledge, except in rare circumstances, lead to medicine-independent mental health. That is, these medicines are not like antibiotics: you don’t take them for a while and watch the illness go away. By contrast, there is increasing evidence for the long-term, post-treatment efficacy of psychotherapy (particularly long-term psychotherapy).
  
  How that relates to the blanket terms “cheaper” and “easier” is not immediately obvious to me.
andreinla

Roughly 315 million prescriptions for a population of 315 million (2008 numbers).

That sounds about right.

I understand that mental illness is crippling and I understand that many patients get more than one prescription.

What I find interesting is the staggering amount of people getting prescriptions. The first thought that comes to mind is that our lifestyles are driving us insane.
- turn_self_off
  
  bascially, money cant buy happiness. At best it gives a short time of bliss right after you walk in the door with todays catch…
angrypaladin

Yknow, yall can be as cynical and luddite about medication as you please, but meds really do help people. There seems to be a lot of arguments here that goes like ‘Oh lordie! Don’t take meds because they’re dangerous! You’ll never REALLY be better and you’ll be on them the rest of your life’.

Ok, I get it. Hey, I even saw the South Park episode where they recommend just beating children instead of seeing a doctor. In fact I used to think that way myself: “Oh I would never take DRUGS, how would I even know if I’m thinking my thoughts anymore? The benefit would only be temporary and I SHOULD be able to overcome my weaknesses by WILL ALONE!” Yeah, well, not so much Heir Ãœbermensch. In case it needs to be repeated, if you’ve ever had coffee, tea, most sodas, tobacco products, wine, beer, or any alcohol or even chocolate then you have consumed a mind altering drug.

Therapy can be great, and it really does work for a lot of folks. It did nothing for me. What’s important to remember is that therapy is like trying to fix your computer by troubleshooting through the operating system. But, if you apply a maintenance plan to the application level with no changes or improvements then it’s time to check the physical hardware.

I realized I had to confront the ADD that I continually told myself I didn’t have and that my father’s belt couldn’t beat out of me as a child and teenager. I was terrified I was going to lose myself and it would just be drugs talking through my mouth. “I mean, my nervous system is the product of natural selection right? How could anything produced by evolution be bad? ADD must have an adaptive advantage! Maybe,” and here’s the evolutionary psychology quantum leap of total bullcrap, “maybe ADD gave a selection advantage to ancient genus homo because they needed to hunt, gather and watch for predators!” Right about then I realized how full of crap I was because evolution doesn’t work like that. Changes in morphology and physiology do not have to have a causal, adaptive advantage. Sometimes changes are maladaptive, though most changes to organisms are completely neutral, and sometimes a change can be a benefit in surprising ways that seems wholly unattached to the apparent purpose of the adaptation. Evolution doesn’t produce the best possible results, just results that are good enough to survive and pass on genes.

I had gotten to the point where juggling work, school and marriage was becoming impossible. The more complex things got, the more introverted I became, pushing myself so deep into Warcraft I didn’t know butt crack from sideways. The reality, now that I’ve been to a doctor, is that I can actually do my work and live my life without someone randomly flipping the channel in my head every three seconds or being consumed by random bouts of deadlock, monochrome boredom or crushing, voids of depression. I’m still myself, just a little different. The meds weren’t a magic bullet, rather, they’ve given me the opportunity to more easily make meaningful, beneficial improvements in my life and in the lives of the people I care about. My co-workers have told me how professional I’ve become, my spouse and friends are amazed that I don’t interrupt them or spend the time they’re talking thinking of the next thing I’m going to say. Hell, even my dentist is happy because I’m not ruining my teeth by slamming coffee and sodas all the time.

Seriously, if you don’t need meds, that’s fine. Great! You’re blessed by whatever pan-universal force or being you consider worthy of veneration. But please, as a favor, just remember that there are some of us who really, honestly do benefit from psycho-pharmaceuticals. Not every doctor is out to steal your money and addle your wits with happy pills.
- mister-o
  
  I believe I was the one who made the point about being on meds for life, so let me, cynical luddite that I am, try to defend a third position that you seem not to allow for (maybe you didn’t mean me with those insults – if so, sorry for being flip). Here’s something else I wrote:
  
  “Mental illness is crippling, and if a pill can get you through the days until it subsides, then for God’s sake, take the pill. Taking pills is not weakness.”
  
  It’s possible to agree completely that psychopharmaceuticals help (indeed, are necessary for) many people while simultaneously conceding that we don’t know why they work, that they don’t reliably cure the disorders whose symptoms they address, that there is sometimes disturbing conflict of interest in the field of psychiatry (not always, probably not even a large percentage of the time), etc. It’s possible to have a nuanced view that is able to laud the advances and promises of the field while acknowledging its flaws and advocating for improvements in the system of care and drug development.
  
  Some people do indeed feel superior that they don’t need meds and shit on people who do. Stigma about mental illness is pervasive and insidious. But it is orthogonal to the very real flaws that exist within the field of psychiatry.
  
  Also somewhat orthogonal: comparing the intake of (say) Seroquel or Xanax to eating chocolate doesn’t do anybody any favors ;) It’s like comparing riding a tricycle to leaping over a semi-truck in a motorcycle, and is probably more likely to get people to dismiss your real insights because they find the suggestion so outlandish.
kc0bbq

You know, sometimes depression is a medical condition…. It’s not always people medicating themselves through the day because they think they’re sad and don’t want to be.

I had untreated depression for about twenty years. When I finally decided to get help with it I was in line to make an appointment after some other appointment. I couldn’t even stay in line. The best I could do stop myself walking away in the parking lot and calling my mother to have her make an appointment for me. At 30 years old. It was the most pathetic I have ever felt in my life. Until a few days later when I was in for the appointment waiting for the doctor, white knuckled grips on the chair. I had to put all the effort I could into holding on to the chair so I wouldn’t just get up and run away. I had never had anxiety issues before this and haven’t since, but I have a lot of sympathy now for people who have to deal with it for real.

Luckily for me, the first thing we tried, Lexapro, worked wonders for me. No side effects except for a bit of giddyness and occasional dizziness when ramping up, but nothing after that. Ended up switching to a generic citalopram and had to go through the dizziness again for a while due to the nature of citalopram vs. escitalopram, but the copays were a lot cheaper. Couldn’t expect to go longer than the first 6 months on free samples. :P

Two years later, I didn’t think it was necessary anymore. Got the OK to ramp down off of it and have been fine since. Again, got lucky, like the drug was formulated with me in mind. I know people who have had horrible luck trying to find something that works for them.

I won’t deny that they’re overprescribed. They’re overprescribed in the same way that Ritalin was/is. But, they’re amazing for those that really need them, if you can find one or a mix of them that works. A couple decades ago there wasn’t much help, if any.
sixohsix

So… more than one out of every ten people in the United States is on medication to control anxiety issues? I think you guys have a problem. We all have a problem.
- Anonymous
  
  I added up all the prescriptions and got that there are more prescriptions than people ?!
Anonymous

which is why our roads are so dangerous. Every other person you see in the oncoming lane is on a med (either prescription or over-the-counter)

I go to a support group once a week, and every single person is on a minimum of two meds. They’re constantly tweaking their dosages, complaining of feeling drowsy or hyper.

bring back passenger rail and trolleys. all these overmedicated folks can sit back and safely enjoy the ride. (unless the guy driving the trolley is stoned.)
daeward

The number of people in America on Xanax exceeds the population of Canada by a third. It’s also about three in every twenty US citizens (~15%)

What.
Angstrom

So,
what are you guys so anxious about?

Do the drugs take away the impetus to resolve the cause of the problem?
- Anonymous
  
  Spot on, Angstrom. Anxiety is a message from mother nature to change something. You’re getting that uneasy feeling for a reason….
  - Anonymous
    
    Yeah, but what if it’s something you can’t change? I’ve been experiencing horrible anxiety from some physical health problems that doctors told me they couldn’t do anything about.
- promethean
  - We’re fighting wars in two countries where every day we are “winning” less.
  - We have a 3rd more abstract “war” on terror which itself generates a substantial amount of fear and frustration
  - We are the proximate if not the ultimate cause of the continued economic collapse around the world
  Despite this, we see ourselves as a good country, and as individuals and even as a country we try to do good things, and sometimes we succeed in this. But the contradictions cause quite a bit of cognitive dissonance, and given all of the above you really wouldn’t want to see what we’re capable off when we’re not taking the edge off with a little xanax. (ok, a lot of xanax)
  - Anonymous
    
    Let’s not forget the 4th abstract war: ”
    the War on Drugs” which by the looks of this list is coming in at a dead loss as well.
    
    This list becomes even more startling with the revelation that most antidepressants are no more effective than placebos, except in severe cases http://www.huffingtonpost.com/dr-mark-hyman/depression-medication-why_b_550098.html.
Anonymous

To #5, laughing in my house by myself
angrypaladin

@mister-o#70 No, actually I wasn’t directing my above post toward you. If it was directed at any one person, I was mocking myself for being a colossally, proud butthead who as unwilling to acknowledge personal limitations and ask for help. I didn’t include any data or statistics because my post was limited to my own subjective opinions concerning my positive results from psycho-pharmaceutical treatment by a particular physician at a distinct time in my life. At no point did I identify my views as being any form of objective maxim that must instantly be adopted by all nor did I dismiss nuanced middle ground. My purpose in posting to a public forum is to read and express different facts and opinions in the hope of generating a new synthesis of information. If my goal was to dismiss all data and opinions not compatible with my own information a priori then I wouldn’t have bothered to post.

“(maybe you didn’t mean me with those insults – if so, sorry for being flip).”
There was really no insult intended other than a lot of self mocking. For example, when I wrote ‘well, not so much Heir Ãœbermensch’, this was a self critical remark about my own mistakes. By framing the criticism in relation to Nietzsche, my intent was to imply the futility of my reliance on romantic notions of a body whipped into disciplined subordination by pure personal talent, following my heart and forcefulness of will alone. If you were insulted I’m sorry and it wasn’t my intention. Addressing myself in third person was ambiguous device.

“Mental illness is crippling, and if a pill can get you through the days until it subsides, then for God’s sake, take the pill. Taking pills is not weakness.”
Actually, I did read the above statement, found it reasonable, concise and articulate. I fully agree and so I’ve no cause to debate this. It seems we’re on the same page here.

“It’s possible to agree completely that psychopharmaceuticals help…”
At no point did I make any claim or criticism about the internal peer review process or politics of either psychologists or neuroscientists. Nor did I at any point state that that current scientific consensus is in any way complete and without valid, critical dissenters. I didn’t claim that the meds themselves are in any way perfect nor did I dismiss any potential dangers and side effects. Again, my above post was limited to my own subjective experiences. I know that there are deadly serious risks that go along with my meds and I take them as seriously as I would any other technology: If used properly and moderately it can be a great benefit, but too much can be a disaster. As an afterthought, I commented that “Not every doctor is out to steal your money and addle your wits with happy pills.” and I think this seems to be a reasonable and plausible statement.

“Some people do indeed feel superior that they don’t need meds and…”
Here I will admit to irrational motivations on my part since I’ve something of a white knight complex. My points were not an attempt to address the medical cost/benefits of current research, but rather the pop culture stigma against people who benefit from practical, medical treatment. Since I myself am a part of this demographic set, I have a personal stake. I’ve lived with ADD most of my life while trying rationalize it away by telling myself that I was a bad, lazy, sullen, anti-social person who’ll never succeed at life. So, I’m pretty defensive of the people who need help and I don’t look too kindly on bullies (which is not a label I’m assigning you mister-o).

“comparing the intake of (say) Seroquel or Xanax to eating chocolate…”
I can see your objection to this comparison and it’s a valid point. Rhetorically speaking humans have trouble making pathetic connections to subjects they have little personal experience of. There’s also, as we agree, a pervasive, negative, cultural bias against mind altering substances and the people who use them. However, this is a stereotype that’s often disconnected from observable, proven utility. Based on this, I mention these common substances as a not-to-subtle reminder to deniers (not constructive critics) that almost all of us have ingested and metabolized mind altering substances at some point in our lives. Like any substance put into the body, an unreasonable excess will usually produce a negative and potentially life threatening effect. Why should the mind altering chemicals in chocolate be any less potentially dangerous than other drugs if abused? Sudafed was available over the counter, but now it’s partially controlled because of its mind altering effects. Statistically, alcohol is the most dangerous, costly and disruptive mind altering drug in America. Do these not fall into the category of mind altering drugs that can potentially have adverse consequences if abused? Why should these commonly available drugs be placed into a special set of exceptions and how do we delineate between the two different sets?
mister-o

If you know anything about bipolar disorder and medications for it, notice that lithium and Depakote
(“mood stabilizers”, but go find out what that term means, find the consensus in psychiatry) didn’t make the cut (though Depakote was in 05). Five anti-psychotics did, though. Why, you might ask? I assure you that it’s not because of increased schizophrenia prevalence/treatment. You might find this explanation plausible, or at least interesting:

http://thelastpsychiatrist.com/2007/04/farewell_depression.html

Note that the link also provides an explanation (albeit a partial one) for why some of the % changes might be so high: the rise of polypharmacy.
- Rindan
  
  If there is one thing I learned from dating a girl who went through a battery of psych drugs is that they all fall roughly in the same category of “We have no fucking clue how this stuff works, what is does, how it does it, or what it will do to you… but it has something to do with your brainz.” I’m not damning psych drugs, I’m just saying that you need to take the labels they give them with a grain of salt.
  
  Just because someone is taking an “anti-psychotic” doesn’t mean they are psychotic. It means they are taking a chemical that is tweaking on their brain chemistry that is some fraction of the population acts as an anti-psychotic.
  
  Psychiatric “disorders” and the battery of drugs used to treat them are maybe a step above leeching at the moment. We don’t even classify most psychiatric disorders by the their root cause. We just classify them by a set of symptoms. It would be like if we classified any time someone had a runny nose and a cough as being “sick”, instead of differentiating between someone with a allergies and a virus, muchless a specific virus or specific allergy.
  
  I’m not shitting on the field. They are doing the best they can and making progress in leaps and bounds, but they are very much in the ‘sawbones’ stage of the discovery.
  - mister-o
    
    Rindan,
    
    What you say is true, but it’s worse than that, I think. Ghostwriting and the burying of study results that don’t convey the desired message spring to mind. But don’t take my word for it (and before anyone asks, it’s not just Big Pharma’s fault). Here are a couple links you might find interesting:
    
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030185
    http://thelastpsychiatrist.com/2010/04/deconstructing_a_promotional_s.html
    
    From the second link, to a point that you touched on:
    “Indications (“antipsychotic”) etc, are descriptors, not identifiers. 15 years ago Geodon was tested for schizophrenia, and found to be effective. Today, it is tested for maintenance bipolar; so we say “this antipsychotic is also effective for bipolar maintenance.” Wrong. That’s an accident of history. 15 years ago they could have first tested it for bipolar, and today done schizophrenia trials, and then we’d say, “this is a mood stabilizer that also treats psychosis.” Both of those statements are empty. It is a chemical, it has utility, not identity.”
dequeued

The people taking anti-anxiety medications is much higher than 40M.
Xanax is just one type of Benzodiazapine, a powerful anti-anxiety medication.

Xanax just happens to be the most popular “flavor” of benzo right now, but the others on that list are Valium, Ativan, which are both a bit more powerful.
Other popular benzos that didn’t make the list are Klenopin, and Serax.
Several of my friends swear by Klenopin.
It’s a longer lasting, but “lighter” Xanax.

Most people I know are taking either anti-anxiety or anti-depressants.
It just crept up on our society I guess, because I don’t think things were always like this.
I can only think of a few people under 30 who don’t take some kind of prescription medication, and I don’t know for sure, most people don’t readily talk about it.
Then again, I live in a very stressful but productive city.

Also notice the high amount of Amphetamine prescriptions.
That’s about consistent with what I’ve seen.
Mixed Amphetamine salts, and Extended Release Mixed Amphetamine salts are just generic Adderall.
They’re very popular with students, and engineers.

Also, from speaking to people, I know that Amphetamine prescriptions are directly responsible for prescriptions for anti-anxiety medication and anti-depressants, to offset the negative side-effects of teh Amphetamines.
- Anonymous
  
  >> The people taking anti-anxiety medications is much higher than 40M.
  
  I doubt it. The numbers presented are NOT the number of people using these drugs, but the number of prescriptions for these drugs. Since a person typically would have several prescriptions a year, the number of people using these drugs is much less. This is pretty obvious, adding the numbers in the chart together would mean pretty much everyone was on something, despite your experience with your circle of friends I don’t think this is true.
- TheCrawNotTheCraw
  
  You claim that Valium is stronger than Xanax.
  
  In my experience, Xanax is about 3-4X stronger than Valium. Xanax was the strongest anti-anxiety med I ever needed to take.
  
  You could sleep through a nuclear war with Xanax. It was a blessing at the time, when my sleep patterns were completely upset.
  
  Nonetheless, because it is a very strong sedative, it is very disquieting to see it being the most prescribed drug.
  
  Finally, my old friend, who is a psychiatrist, said that he never wrote a prescription for Xanax.
  
  And beware of Effexor. Google “Effexor withdrawl” (with the quotes) and you’ll see what I mean. Worst med I ever withdrew from.
  - dequeued
    
    I think any benzo will be very powerful if you have no tolerance for it.
    
    If you take Xanax a few times a month, then taking Valium or Klenopin will be much more powerful.
    
    Also, I agree that anti-anxiety medications are used as replacements for alcohol.
    1MG of Xanax is roughly equal to a glass or two of red wine, only it lasts much longer.
    
    And you’ll never be fired for taking clinically prescribed medication at work.
dequeued

Oh, also, another trend I’ve noticed recently is off-label prescriptions of anti-psychotics.

Drugs like Trazodone, and Serequil, are now finding new life as sleep aids.

I am a bit concerned with the number of people who have been taking highly addictive benzos for several years, when, it says in everything I have read about them that they should only be prescribed for short-term treatment.

A friend of mine who takes Klenopin every day is great with it, but she cannot quit or she will go through painful withdrawal, so she has just given up.
- hassenpfeffer
  
  Trazodone (brand name Desyrel) is an extremely sedating antidepressant, not an antipsychotic.
  - Anonymous
    
    I took trazodone for a number of years (2 or 3) as an off-label for my severe insomnia. Did the tests before starting it, and it wasn’t apnea. Worked OK at first, but then I became acclimated within a year, and started using the trazodone along with melatonin and light therapy, and it was about 80% effective. Gave it up for pot, and never looked back!
Anonymous

As a psychiatry resident, let me make a couple of comments about this.

First, the implicit message of this entire post on boingboing seems to be to point out that society is a bunch of complainers who fall for drug company advertising and the sinister/incompetent mental health professions who want to medicate everyone into submission. I would argue that the correct take-home message is that the public health burden of mental illness is much larger than the layperson appreciates. For example, depression is the #1 greatest cause of morbidity/mortality worldwide, which is something most people find surprising. Many people do not believe mental illness exists at all, as if the most complex organ in the body were somehow immune to dysfunction, while simpler organs break down all the time. Of course, this is largely because of the stigma associated with mental illness, which causes people to keep their problems secret, leading the layperson to believe that mental illness is somehow rare, when in fact it is unfortunately very common.

Second, the vast, vast majority of “psych” meds on this list are not prescribed by psychiatrists, but by primary care MDs/NPs/PAs. The real issue in mental health right now is lack of access to care. This ties in to the common misconception that psychiatry as a field wants to overmedicate people. Of course, there are certainly people who are overmedicated, but in my experience the far bigger problem is underutilization of psychotherapeutic approaches, which is not driven by psychiatry itself, but rather issues of limited access, insurance, cost, and patient compliance.
- Anonymous
  
  Thank you psychiatry resident, #60, for your perspective, with which I totally agree. disorders are far more common than lay people can admit. With the science of brain neurology expanding and with the proof of CAT scans and MRI’s, these meds are being prescribed to treat medical conditions. Why is that bad? What about those of us who it actually helps?
Anonymous

I was pretty shocked to see how many prescriptions there are for these drugs, but I was more shocked to see all the comments here from people making claims that they don’t even know anyone who isn’t on drugs like these. Where are you people from? Granted it’s possible that people I know don’t discuss it, but I don’t know anyone who’s ever even eluded to being on one of these drugs.

Is it cultural? Is it regional? Is it based on age? What are the demographics of this massive number of Americans on these drugs?
DrPretto

As a physician (I am not a Psychiatrist, but I can order many of those meds in my country), I found interesting that the top 3 are Benzodiazepines (Diazepam derivatives) primary used to treat anxiety disorders, the problem with this kind of meds is that they are ADICTIVE. Millions of people in the world are or were addicted to Valium (Diazepam) now they changed their addiction for newest and better but still adictive meds. I think we need better regulation for the prescription of this kind of meds.
snoproblem

Generation SOMA is off and running.

“Home of the brave”? A too-large number of you are taking pills to prevent soiling your shorts from anxiety.
- DrPretto
  
  Hey, interesting that Huxley and Brave New World reference, did you saw the movie THE ISLAND, one of my favorites.
  - snoproblem
    
    Not yet. You’re implying that the storyline is Huxley-esque? I’ll give it a try – a little dystopian fic never hurt anybody. ;)
    
    Unless it actually comes true of course, sigh.
    - DrPretto
      
      The Island movie info here, Huxley-esque for sure, one of my favorite writers if not my favorite.
      Original, Intriguing and Scary View of Science, Ethic and Future Society
      http://www.imdb.com/title/tt0399201/
Anonymous

phisrow hit the nail on the head on this one…people have always been stressed but in the past both alcohol and drug use were very, very common as well as legal. I read a lot of old newspapers online and “tonics” were heavily advertised (e.g., Mrs. Winslow’s Soothing Syrup (which was sold to help babies sleep) and contained a hefty dose of morphine.) There was also a “tonic” housewives took that was a hefty dose of alcohol per spoonful.
DrPretto

By the way I think Prozac was very important as the first Inhibitor of Serotonin Recapture, but that was many years ago and now we have more selective meds of the same action mechanism, I think Prozac should no longer being used we have better alternatives with less side effects (paroxetin and Sertralin for example).
Another advice: People PLEASE STOP USING ANPHETAMINES, they are VERY DANGEROUS TO THE BRAIN
noah django

this thread is depressing the shit out of me.
ncinerate

This chart is scary…

Are non-medicated people such as myself truly so rare? Are there that many people with real depression and anxiety issues that need medication or is this just a sign of massive recreational use of prescription medicine? The thought makes me very very anxious and depressed, I might need some xanax…

The only mind-altering drug I occasionally partake in is alcohol, and that’s only because of a life-lesson taught to me by my father at 12 years old.

He handed me some jack and coke and told me to drink it. I attempted to refuse, saying I didn’t need to drink. I’ll never forget his reply.

“Son, alcohol does many things to men. It makes some men angry, some sad, some sleepy, and some very very stupid. It also makes every woman I’ve ever met horny, so you’re going to learn how to drink it. Drink slow, keep your head, never drink alone or drown your thoughts. You’ll thank me later.”

Thanks, dad.
Anonymous

@phishrow
the “real” 2010 edition

1) marijuana
2) caffeine
3) ethyl alcohol
4) tobacco
5) xanax

I think we could kill a few birds if we could all just get stoned legally
DrPretto

The only medical uses I know for Amphetamines (Metamphetamines) are as Narcolepsy tratment, Attentional deficit disorders on children and some people used it as treatrment to obesity (I personally would not use it totreat obesity).
They are really Dangerous to neural system if used without control.
ill lich

I wonder where the world is moving. Are we making it an unbearable place, and so need to manufacture chemicals to make life bearable? I realize this is just a chart of psychiatric drugs, so naturally it’s all anti-depressants (schizophrenia or Tourette’s isn’t as common as depression), but the chart still makes me wonder.
- phisrow
  
  The world is definitely pretty ghastly, in numerous respects; but there is an important matter of perspective to keep in mind: Prescription anxiolytics and antidepressants are easy to measure, and their use is rising rapidly; but society’s total use of anxiolytics and antidepressants needs to count the prescription stuff along with various over-the-counter and illegal compounds.
  
  Some of the uptick is, almost certainly, tied to the fact that modernity is a grim, perpetually uncertain grind. Some of it, though, is more likely due to the fact that you can now get fired for drinking during lunch hour on workdays. A mg or two of Lorazepam takes the edge off to much the same extent that a unit or two of alcohol does; but is virtually undetectable by sight or scent and possesses the validation of a Doctor’s prescription.
  
  People have been altering their moods chemically since forever(observe the archeological pot stashes going back 10 millenia or so, or some of the crazy shit that went into patent medicines and “nerve tonics” and such. The really dramatic difference in recent years is that a lot of that mood altering is now being done with agents that have some degree of scientific testing, and under something resembling the supervision of a physician…
nutbastard

that being said, most people on xanax probably are using it recreationally or as an escape from problems they could be working on fixing.

my experience with it was sort of ‘huh, i feel kinda drunk and good.’ it’s like weak ketamine, nothing to write home about.
sterling

Those Cymbalta commercials seemed to have helped its numbers, a 237% change! Though in the spirit of full disclosure I have to say I have contributed to those numbers.
There are several snarky comments here regarding Americans taking too many meds. While there may be plenty of people who take any number of prescriptions unnecessarily do not discount the debilitating affects depression and anxiety can have on someone. Personally, I don’t know if I’d even be here today without counseling and decent pharmaceuticals.