| 词条 | Draft:Antidepressant Consumption |
| 释义 |
HistoryFrom the 1950s’ scientific pharmacology perspective, the therapeutic approaches to affective disorders was introduced with imipramine and iproniazid.[4] “The clinical introduction of psychotropic drugs in the 1950s constitutes one of the great medical advances of the 20th century, and the importance of the event has been compared with the discovery of antibiotics and vaccines.”[5] “In the early 20th century, experimental testing of the scientific basis of psychoactive effects of drugs with opioid alkaloids led to coining of the term psychopharmacology.”[6] Psychopharmacology is traced to the late 19th century drug treatments that were used in insane asylums, although they were remained poorly understood.[7] “It was in the 1950s that a veritable revolution took place in the fields of psychopharmacology and psychiatry, with the clinical introduction of the main groups of psychoactive drugs still used today.”[8] The introduction of this studies resulted in a strong change in the concepts and acceptance of mental illnesses, mental health services, development of psychiatry and high technology economies in both clinical and public health views.[9] “Since its inception during the early 20th century, psychopharmacology has brought important and farreaching medical and social changes.”[10] An important part of this innovations has been the antidepressant agents. “The utility of antidepressants quickly expanded to include other conditions: many antidepressants also effectively treat anxiety disorders and the chronic pain associated with disorders such as diabetic and postherpetic neuralgia.”[11] Medical UseMental IllnessesAntidepressants are used for treating mental illnesses, such as; Major depression, Dysthymia, Anxiety disorder, Obsessive-compulsive disorder, Bulimia.[12]Today, in USA, antidepressants are the most commonly used pharmaceuticals for treatment of depression diseases, despite the psychiatric treatments.[13] Other ConditionsAntidepressants have been providing mixed analgesic success in patients with chronic painful discomfort. People consult with somatic complaints for non-specific pain, for example; headaches and muscle aches. They are also being used for the feeling of malaise, decreased energy and insomnia. Clinical trials show that Amitriptyline treatment relieves chronic pain, diabetic or postherpetic neuralgia in up to three quarters of patients.[14]Usage RatesInvestigations into the link between antidepressants and suicide show that the use of antidepressants lowers the risk of suicide in patients. However, the leading cause of suicide remains to be depression. The investigations also highlight the increased use of antidepressants in our society[15]. Antidepressant UtilizationNowadays antidepressants are the most accepted treatment for mood disorders, but it’s necessary to correctly diagnose patients and to closely monitor the patient's reaction to the drug. To help spread information to doctors, there are special programs to learn about treatments for depression, as well as ways to combat suicide, and provide primary health care for depression.[16] To support the use of antidepressants, the statistic was given that currently in Europe there is a direct correlation between the increase of the prescription of antidepressant drugs and the decrease in the amount of diseases associated with depression. The study revealed that when antidepressants were prescribed to children and adolescents under 18 years, with a diagnosis depressive disorder, the benefits were outstanding, but there still appeared to be a small increase in the risk of suicidal behaviour which was deemed acceptable.[17] Analysis of the US Veterans Affairs Medical System record data of more than 200.000 adults diagnosed with depression and followed up for at least six months, showed a statistically significant decrease in suicide rates in individuals who were treated with antidepressants. Thus, an ambiguous conclusion was made. The tendency of depression in adolescents is quite great and, moreover, continues to rise. Behind these kinds of diseases multiple factors are hiding, which may not be able to be explored until the end. Certain conditions and contexts of economic development correlate with lower suicide rates, while alcohol consumption, divorce in both men and women, and unemployment correlate with higher suicide rates.[18] Considering the use of antidepressants on the example of several countries, there is a tendency in Europe and the United States to increase using of antidepressants and each country is looking for different ways to deal with psychological disorders. The correlation between the consumption of antidepressants and reduction of risk of suicide is clearly seen in the countries taken.[19] It is possible to highlight general reasons of disorders is depression but it is impossible to draw an unambiguous conclusion regarding the positive effect of consumption of psychopathology drugs, as there is still a lot of subtexts of the original variance.[20] WorldwideIn countries Norway, Denmark, Finland, Hungary, Sweden and the United States rates of suicide had decreased by 19% (1996) conversely using of antidepressants is increased a 3.4-fold. The goal of the study was to show that suicide without prior depression does not occur. The total use of antidepressants in Sweden in 1990 was sufficient to treat less than 1% of the population, while the prevalence of depression was around 5% of the population. Due to treatment with various antidepressants in 1990-1991 (according to the study), the risk of suicide decreased to 100 cases. The researchers suggested that if the suicide rate is reduced by another 25%, the use of antidepressants will increase by a factor of 5.[21] In 1996, the number of suicides in Sweden decreased by 19% and the use of antidepressants increased 3.4 times. There is a similar correlation in Australia, Sweden, Denmark, Finland, Great Britain, Hungary, Israel, Italy, Japan, New Zealand, Norway, Slovenia and the United States, as well as from 27 other countries studied. Scientists have called this phenomenon "medical breakthrough". Only one study that was conducted in Iceland (population 285,000) did not show a lower mortality rate from suicide after the introduction of antidepressants. It is difficult to determine the causal relationship of each suicide separately, which would reveal the exact empirical conclusion, but it is clear that behind each suicide is depression. Consequently, a large amount of evidence has been accumulated over the years supporting the hypothesis that treatment with antidepressants prevents suicide.[22] ItalyDepression is the most common emotional disorder that affects more than 350 million people of all ages. In Italy, 4,712 people participated in a study between 2001 and 2003, the study showed that in a lifetime one in five people experienced depression or mental disorder. It should be noted that the number of diseases among women is 3 times higher than that among men. In Italy, as in the whole of Europe, there is a tendency to increase the use of neuropsychiatric drugs with the increased number of cases of depression. A study from 2000 to 2011 showed that in general there is an upward trend in the consumption of antidepressants. By 2011, the rate of consumption of SSRI and other antidepressants had increased.[23]However, according to a recent report by Connolly and Thase, the latest ketamine testing did not satisfy the results of modern treatment. Scientists have concluded that, the drugs that modulate glutamatergic neurotransmission may be useful for providing rapid and greater antidepressant effects among patients who have not responded to SSRI. Additionally, the growing use of antidepressants, as Ilyas and Moncrieff have suggested, is because not all people are prescribed drugs with an accurate diagnosis of mental disorder, but also for mild depression, panic attacks, anxiety or a wide range of other things. For Italy and Europe, the economic issue of antidepressants is very important, as the use of these drugs borders on the cost of health care and the introduction of measures, such as tighter control over the use of these drugs and a public health campaign to reduce risk factors for poor mental health, by reducing stress. From this point of view, the meta-analysis showed a possible 11% improvement in depression. Thus, this shows an increase in use of antidepressants and an interesting fact about how to solve the problem of mental disorders, in terms of health, without the use of drugs, in order to save money.[24] AmericaThe studies focus on the role of antidepressants and the decrease of the suicide rate in the United States. One study was conducted by analzying the relationship between suicide, antidepressants, unemployment and alcohol consumption. With the introduction of SSRI’s, statistics from United States show that from 1985 to 1999 the crude suicide rates decreased.[25] The studies claims the most likely effect is that the increase of the prescription of antidepressants lowered the rate of suicide because antidepressant drugs have a positive effect on patients that suffer from psychological diseases that cause patients to commit suicide. It reveals that twice as many females were prescribed antidepressants as men, and that the suicide rate in women decreased by the same factor compared to men. During this time the unemployment rate dropped and there was an increase in the amount of alcohol being consumed, but multiple studies show that there is no clear correlation of these factors to the decline of the suicide rate. While the number of suicides increased due to overdose of antidepressant accounts for 3-8% of all suicides, the study shows that SSRI’s have a lower risk of suicide by antidepressant overdose than that of TCA’s. The study concludes that the most of those who commit suicide are found to have had some form of depressive disorder, and that there is the need for better screening and recognition of depression by doctors.[26] AdvertisingThe media’s affect on public health has an important function. Antidepressant advertisings tends to overstate the effects of the medicine, while misrepresenting the mental illnesses.[27] “More than one half of the U.S. public describes national, local, or cable news as the most important source of health information.”[28] “In situations in which there is uncertainty regarding the risks and benefits of medical care, the public looks to the media to flag potential safety problems, to interpret scientific data, and to identify qualified experts to comment on how to weigh risks and benefits.”[29] Thus, antidepressant consumers’ connection to cultural representations of prescription drugs are different.[30] “Consumer cultures that form around prescription drugs may help illuminate how lay cultures form in response to commodification.”[31] The connection between the production and consumption of antidepressants has changed as their uses have increased and antidepressants have became commodities.[32] Estimated numbers of global sales of antidepressants and mood stabilizers were 10% increased in 2003 to $19.5 billion, meaning that antidepressants are rapidly becoming a globalized commodity.[33] “It seems likely that the introduction of direct to consumer (DTC) advertising of prescription drugs to the US market in 1997 has encouraged the formation of consumer cultures.”[34] The gap between the healing process of an illness and the experience lightens one’s self-narratives, that does not belong to that individual in the first place, indicates a threat of commodification.[35] “Due to the strong social stigma surrounding mental illness, even family members may keep their antidepressant consumption secret from one another until it seems likely that another person can benefit from this information.”[36] Being included in a community of antidepressant consumers is suggested to be decreasing the social stigma on antidepressants.[37] The social stigma of using antidepressants and commodification of antidepressants are related, even though commodification reduces the stigma, it is not suggested as the best way to create public awareness about treatments.[38] “The cultural circulation of antidepressants in the media has raised public awareness of treatment options while at the same time failing to provide rich and diverse illness narratives.”[39] Avoiding stereotypes can decrease stigma but not the process of commodification. “Commodification of an illness can threaten a consumer’s singular experience, suggesting that their pain and suffering is common and meaningless.”[40] The discussion about understanding the problem should include the cultural processes of stigma and commodification in the context of consumer cultures.[41] “A true understanding of DTC advertising must include an analysis of consumer cultures.”[42] Both positive and negative outcomes of the commodification of antidepressants can be suggested; antidepressants can save lives by reaching out to more people with an expanded market, or they can be the reason for increased cost of healthcare (in this case for U.S.), leaving people with not affordable insurances.[43] Direct to Consumer AdvertisingDirect-to-consumer (DTC) advertising of prescription drugs, which is defined as any promotional effort by a pharmaceutical firm to present a prescription drug to the public by media, has been an important part of the antidepressant advertising subject in many ways.[44] Direct-to-consumer advertising refers to traditional communication tools that involves marketing communications, such as print and television.[45] The aim is to create an advertising model that is focused on the exposure, awareness and action in antidepressants.[46] “This model holds that (1) advertisement exposure raises consumer awareness of conditions and treatments; (2) increased awareness motivates patients to seek medical care and request drug therapy; and (3) patients’ requests lead, ceteris paribus, to increased prescribing.”[47]United States is the only industrialized country that utilizes this model.[48] “In a recent survey more than one-third of respondents reported asking their doctors for information about a drug they had seen or heard advertised, and nearly a quarter asked for the drug itself.”[49] People who have been diagnosed with a condition, who are taking other medicines, who had exposure to magazines, who are in poor health, who had health care coverage are suggested to be the ones to be more aware of the DTC advertisements.[50] “In a consumer survey carried out in the greater Baltimore area in the early 1990s, most respondents believed that DTC advertising could educate the public and would not be confusing to consumers.”[51]RegulationsFDA -Food and Drug Administration- assessed regulations for this industry in 1938.[52] “This early regulation addressing advertising to physicians is still the standard by which all drug advertising is judged; however, much has changed since 1938.”[53] Through the advances in advertising and new media, subjects such as the audience segmentation, production quality and access to information expanded.[54] “First, in 1985, DTC advertising in print took off when a government notice stated that “current regulations governing prescription drug advertising provide sufficient safeguards to protect consumers”.[55] This meant that the direct-to-consumer advertisings must had a summary to fulfill FDA requirements.[56] Then, in 1997, the FDA relaxed the restrictions on direct-to-consumer advertising, allowing antidepressants to become a class of heavily advertised drugs.[57] “A 134% increase in pharmaceutical sales between 1997 and 2000 reflects the fruits of this advertising expenditure.”[58]ConcernsDirect-to-consumer advertising involves some concerns in six matters; not being effectively educational, lacking the information between risks and benefits, having impact on doctor-patient relationships, rising the cost of prescription drugs, lacking the needed resources for regulations and false diagnosis of patients by gender.[59] “A large body of research shows direct-to-consumer (DTC) prescription drug advertising has strong potential to influence consumers’ health cognition and behavior.”[60] Studies address this by exploring how being exposed to direct-to-consumer advertising influences consumer perceptions about diseases.[61]Eli Lilly being the first pharmaceutical manufacturer, Prozac was the first brand to advertise in direct-to-consumer approach, thus it has the highest placement in the DTC publications, during the period of August 1997 and April 1998.[62] Using taglines such as “Welcome back”, “When you know more about what’s wrong, you can help make it right” and “Your life is waiting for you”, the brands are implying that depression can be easily erased with the use of pharmaceuticals.[63] “With stigma reduced, the you becomes an individual abstraction, and the symptoms of depression become at once less threatening, more manageable, and personal.”[64] The concerns are mainly born from the causation, that is given as a reason for biochemical forms, which means that it marginalizes the psycho-social causes for depression, thus minimizing other reasons for depression and it’s impact on society.[65]The way risks and benefits of the antidepressants framed in DTC advertisements are seem to be underprivileged for the risks, while benefits are highly privileged.[66] Framing antidepressants as a quick way to fix the problem causes a more complex situation, where minimizing risks are defined as problematic, dangerous and unethical.[67] The influence of social interactions and social relationships on one’s orientation towards antidepressants cannot be separated from the subtle effects of labeling depression as emotional deviance.[68] “Tragically, the limited images of mental illness, healing and medicine that are circulated in the media tend to misrepresent the experiences of the mentally ill and distort the effectiveness of antidepressants.”[69] Popular CultureCinemaSide Effects (2013)Directed by Steven Soderbergh, in Side Effects (2013), Emily shows depressive and suicidal tendencies after her husband gets out of prison. She goes to the psychiatrist Dr. Bank, he gives her Ablixa, which is an experimental new drug for treating depressive disorders. The side effects of this drug are seen in Emily and events starts to develop. The movie’s stars are Rooney Mara, Channing Tatum and Jude Law. IMDB score is 7,1.[70] In the movie, the name of Zoloft and Effexor –antidepressants- are seen. The movie creates a doubt about the use of antidepressants in society and shows the problematic elements of the psychiatric world.[71] There are series of questions being asked: “Do psychotropic drugs do more harm than good?’’ The movie brings light on an issue about a significant backdrop of some of the major, violent news stories in the world: “Is there a connection between psychotropic drugs and violent behavior?’’[72] Prozac Nation (2001)Directed by Erik Skjoldbjærg, in Prozac Nation (2001), Lizzie is an award-winning student at Harvard University. In Harvard's first year, she is struggling with her depression because of her family problems. She goes to the psychiatrist Dr. Diana Sterling and she starts to take Prozac. However, Lizzie thinks that the pills have depleted her life and she faces difficult choices about her future. The movie’s stars are Christina Ricci, Jonathan Rhys Meyers and Jessica Lange. IMDB score is 6,3.[73] In 1994’s Prozac Nation: “Young and Depressed in America”, which is a book written by Elizabeth Wurtzel. The book was a best seller, young adults has seen this book through one person’s perspective on a growing trend against using antidepressants. But 5 years later, Prozac was available and people have found the right antidepressant experience of Wurtzel.[74] In 2001, the movie of the book was made. The movie mentions about the dependence of many people on drugs, the dependence that implies a need for social normality, psychic equilibrium, because this conforms to the standards of a community, a city, a country and so on. The movie shows lots of Americans consuming antidepressants. Even though this may represent a positive condition, it changes from personality to temperament and character of an individual.[75] TelevisionManiac (2018)Maniac (2018), created by Cary Joji Fukunaga and Patrick Somerville, is a tv series that’s been streamed by Netflix in 2018. Annie and Owen participate in a pharmaceutical testing program. But in this program, the computer which conducts the test, starts to have some problems. The test does not go as they hope. The stars of the series are Jonah Hill, Emma Stone and Sonoya Mizuno. IMDB score is 7,9.[76]The series show that life is difficult in many ways. There is an experiment process and the subject group is involved in a 3-pill experiment.[77] They go through a process that “‘cures’ people’s mental anguish by guiding them through a process, that forces them to identify and confront whatever is holding them back from happiness. In the series, creators of pills says that to know oneself is to be truly happy and aim to chemically facilitate the kind of self-knowledge that takes humans years to accomplish, if they ever truly do”.[78] See Also
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