Depression meds: what happened to sadness?

I read this CNN article about depression meds (”CDC: Antidepressants most prescribed drugs in U.S.”) and felt a rant coming on. The story’s example is a woman who does not wish to confront her husband about his irresponsible financial practices, so her doc prescribes antidepressants. She feels better thereafter. I don’t have a comprehensive CPT code book or a DSM-IV manual here in my office, but I think I’m on solid ground assuming that “lack of backbone” is not a psychiatric or medical diagnosis that necessitates treatment with psychotropic medication.

CNN picked an absurd example to prove its point, but other examples abound in the world around us that are really very similar, and I think we as a society have become inured to this phenomenon. It is extremely common to hear people who have lost a spouse, gone through a divorce, or received a terminal disease diagnosis to report taking antidepressant medications as a result. These folks aren’t depressed. They’re SAD. They’re experiencing a reasonable and expected human response to a disturbing event or series of events—NOT a disease process. And, as with the woman exemplified in the CNN article, by taking these drugs instead of dealing with the problem at hand, they are just putting off eventually having to do it. Isn’t this a bad idea? It seems like chemical rationalization to me, by which I mean the following: it is no different from making up REALLY GOOD reasons why I don’t really need to write my stress management paper yet (I can deal with it later, after all…).

These medications are not, but should be, restricted to individuals with the actual psychiatric disorder of major depression. “Depression” has come to mean “sadness” in our society, and this is a bad idea. It pathologizes an entire range of normal human emotion and makes those who choose to admit and process their sadness seem abnormal or even “in denial” and “in need of treatment.” Sadness is not depression. If someone has lost a spouse, has had to put her cat to sleep, or any number of similar saddening events, she probably DOES weep and have difficulty getting out of bed or concentrating: looks like depression, but is not depression. “Depression” is not being able to get out of bed and staring at the ceiling all day thinking of ways to kill yourself and, more importantly, trying to figure out how to get the energy to do so. It is not in response to an EVENT.

Zombifying our population is not an answer. Physicians seem to have no problem handing out these meds like candy to anyone who asks, and patients are asking. Oh boy are they asking. No one WANTS to feel bad. But what ever happened to giving other things a try first? Some folks need these meds: no doubt about it. But most don’t, and no one can tell the difference if our entire populace starts popping pills at the first sign of an emotional twinge.