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As moods sour, med use soars

Americans take an amazing number of medications in an attempt to ease their anxiety or relieve their depression. According to our calculations, more than 280 million prescriptions are dispensed annually for antidepressants and anti-anxiety agents.

A new report from the Centers for Disease Control and Prevention (CDC) reveals that one person in 10 takes an antidepressant. Nearly as many swallow sedatives.

During the 1970s, Valium and Librium were household names because they were among the most prescribed drugs in America. Today, generic anxiolytics like alprazolam, lorazepam, clonazepam, diazepam and temazepam have replaced the old brand-name nerve pills. Antidepressants such as sertraline, citalopram and trazodone compete with brands such as Lexapro, Cymbalta, Effexor and Pristiq.

It's hardly any wonder so many people are taking such drugs. We live in stressful economic times. Counseling can be expensive. Even if someone has insurance, there is often a cap on how many sessions a person may get with a psychotherapist. A $4-a-month generic drug seems like a cost-effective substitute.

According to the new CDC report, fewer than one-third of those taking an antidepressant medication were treated by a mental-health professional in the past year. That means the majority of the prescriptions may be written without an in-depth understanding of the benefits and risks of these drugs.

For example, the majority of the prescriptions for antidepressants are being used to treat mild to moderate depression. Prescribers such as family-practice physicians, nurse practitioners and internists may not realize that the Food and Drug Administration has approved such drugs for treating "major depressive disorder," but not for mild to moderate depression.

A meta-analysis of well-conducted clinical trials has found that the benefits of antidepressants for people with mild or moderate depression were "nonexistent to negligible" compared with placebo (Journal of the American Medical Association, Jan. 6, 2010). That means millions of people are taking medications that may not help them.

These drugs do have side effects, however. Some people experience headaches, nausea, dizziness, diarrhea, anxiety, insomnia or sexual dysfunction.

Prescribers don't always warn patients that both antidepressant and anti-anxiety drugs may be very hard to stop. They may not have a detailed plan to help patients withdraw from drugs like alprazolam, lorazepam, sertraline or citalopram.

We offer more information on these medications in our free guides to Antidepressant Pros and Cons and Psychological Side Effects at www.peoplespharmacy.com.

To learn more about effective nondrug approaches, we offer our Guide to Dealing With Depression. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (64 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. E-7, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Anti-anxiety agents and antidepressants can be very helpful, especially when combined with therapy. To be used effectively, however, patients and prescribers should be aware of their benefits and risks.