Psychiatric Disorders and the Medication of America

1. A Diagnostic Epidemic

Psychiatric Disorders—and Prescription Drugs—on the Increase

Outpatient Treatment, 1987 and 1997
Outpatient Treatment for Depression, 1987 and 1997
Source: Olfson et al., JAMA, 2002

A number of recent studies have documented dramatic increases—a virtual epidemic—in the diagnosis of psychiatric disorders in the United States. One study by Mark Olfson and his colleagues, which appeared in the Journal of the American Medical Association (JAMA, 2002; 287:203-209), found that the rate of outpatient treatment for depression tripled in one decade from 1987 to 1997 in a representative sample of the U.S. population. Furthermore, as shown in the graph on the right, the proportion of treated individuals who were prescribed SSRIs such as Prozak or other antidepressant medications doubled from 37.3 percent in 1987 to 74.5 percent in 1997. Over the same time period, the proportion of outpatients who received psychotherapy (the "talking cure") declined from 71.7 percent to 60.2 percent.

Olfson and his colleagues discuss a number of factors and developments that may have contributed to these pronounced increases in the diagnosis of depression and the use of antidepressant medications for treatment. In particular, they point out that introduction of Prozak in 1987 as well as other SSRIs in subsequent years may have made physicians more willing to prescribe psychotherapeutic medications and "tipped the balance in favor of diagnosing and treating depression." They go on to elaborate on the important role of drug companies and the mass media in this process:

The pharmaceutical industry...engaged in a concerted effort to promote the increased sale of these new antidepressant medications through vigorous advertising campaigns directed at physicians, other health care professionals, and more recently the general public. In addition, medications to treat depression have been a featured national news magazines, best-selling books, and widely watched television talk shows.... As a result of these developments, the public may have become more accepting of pharmacological treatment of depression.

The Medicalization of Childhood

Kids and Prescription Drugs

Olfson and his colleagues have also documented some striking increases in the treatment and control of children with psychotherapeutic medications (Journal of the Academy of Child and Adolescent Psychiatry, 2002; 41:514-521). Using data on outpatient treatment similar to those in the study described above, these researchers found that the overall rate of psychotherapeutic drug use for children 18 years or younger almost tripled from 1987 (1.4 per 100 children) to 1996 (3.9 per 100 children). More specifically, the use of stimulants, such as Ritalin or Adderall, which are used to treat children diagnosed with ADHD and similar conditions, quadrupled in a decade. They found a similar rate of growth—over a 400 percent increase from 1987 to 1996—in the treatment of older children aged 15-18 with antidepressants.

A more recent study by Vitiello and his associates indicates that these upward trends in the medicalization of children's moods and behavior have continued into the 21st century (Journal of the Academy of Child and Adolescent Psychiatry, 2006; 45:271-279). These researchers found that the use of antidepressants by young people aged 13-18 almost a doubled in the five year period from 1997 to 2002.

Similarly, Moreno et al. (Archives of General Psychiatry, 2007; 64:1032-1039) found that youths under the age of 20 were far more likely to be diagnosed with bipolar disorder in 2002-2003 than in the previous decade. The rate of office visits by young people that involved a diagnosis of this serious mood disorder grew from only 25 per 100,000 in 1994-1995 to 1003 visits per 100,000 eight years later--a 40-fold increase! Moreno also found that over 90 percent of youths diagnosed with bipolar disorder received mood stabilizers, antidepressants, antipsychotics, stimulants or some other kind of psychotherapeutic drug during their office visits in 1999-2003, with nearly two-thirds of them (62.7 percent) receiving a combination of these medications. Thus, the exponential increase in the labeling of children and adolescents as "bipolar" represents a very important growth sector for the pharmaceutical industry.

    Index Page