National Post

Saturday, November 02, 2002

Use of antidepressants skyrockets

Young, old taking more

Heather Sokoloff
National Post

Canadians filled 30.3 million prescriptions for antidepressants in a year, an increase of 40% since 1997, with young people and seniors increasingly using the drugs.

Much of the rise comes from Canadians' continued infatuation with a new class of drugs that provide relief from the blues with few side effects, called selective serotonin reuptake inhibitors (SSRIs).

In the 12 months up to September this year, 13.5 million prescriptions for SSRIs were filled, more than double the 1997 amount, reports IMS Health, a Montreal-based company that tracks drug sales.

"That's a very anxious nation," said Dr. Ariel Dalfen, a psychiatry resident at Mount Sinai Hospital in Toronto.

Dr. Dalfen said the drugs are increasingly being prescribed to young adults, teenagers and even children as young as five. The drugs are often used to treat problems such as weight loss, eating disorders and PMS.

More seniors are also being diagnosed with depression, reported Dr. Nicole Didyk, a geriatric medical specialist at St. Joseph's Hospital in Hamilton, Ont., although doctors sometimes mistake early dementia and Alzheimer's in seniors for a depressive disorder.

"I think depression is kind of a tricky thing," said Dr. Didyk. "In some cases, people are on these drugs who do not need them. But also, there are a lot of depressed people that are not being treated."

But doctors cannot say whether more people are depressed today than in the past, or whether doctors are writing so many prescriptions because the drugs are easy for patients to take without fear of overdose or addiction.

The SSRIs, commonly known by the brand names Paxil, Celexa and Zoloft, regulate the body's production of serotonin, bathing the brain in the hormone linked to mood and anxiety.

Paxil is now the eighth most prescribed drug in Canada, with 3.4 million prescriptions dispensed last year, up 19% from 1999.

Depressed individuals taking the medication quickly begin to feel more energetic and are able to accomplish daily tasks with greater ease. "They start to enjoy life more, they start sleeping more," Dr. Dalfen said. "Their appetite comes back. Later on, the mood will pick up."

The most commonly reported side-effect is decreased interest in sex and difficulty reaching orgasm, she added, and some patients report difficulty sleeping and head and stomach aches.

Canadians also filled 11.1 million prescriptions for benzodiazepines, another class of antidepressant primarily used to treat acute anxiety. Drugs such as Ativan and Apo-Lorazepam are highly addictive and sedating, Dr. Dalfen said.

Antidepressants, which garnered $895-million last year in Canada, are aggressively marketed by pharmaceutical companies to psychiatrists and family doctors. The companies offer gifts such as cruises, computers or hockey tickets to win the doctors' loyalty, said Dr. Dalfen.

Canada is the seventh-largest market for pharmaceutical sales in the world.

Dr. Kim Maertz, a psychologist at the University of Alberta's Student Counselling Services, said young people entering university and looking to go on to professional and graduate school are facing mounting pressures.

"Ten years ago, you could get into any faculty in university. Today, the standards are very high in every program.

"We are more inclined to make a referral [to a physician], along with counselling. Its more acceptable to look at the chemical components of depression today than it was in the past."

Doctors are wary about saying the drugs are over-prescribed, as depression traditionally went untreated in individuals too ashamed to seek medical counsel. Much of that trend has been reversed -- people are more willing to talk about depression since the disease got play on the Sopranos and celebrities such as actor Drew Carey publicly discussed their battles with the disorder.

Canadians go to the doctor for depression more often than for any other ailment except high blood pressure, IMS Health reported last year.

High blood pressure continues to be the No. 1 reason Canadians see a doctor, with more than 16 million visits last year. In 1995, depression was the fourth-ranked reason to see a doctor.

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