Instead of monopolizing the comment wall, I thought I would start a new discussion on this most interesting topic. My source for antidepressant prescription rates is this report from Express Scripts. I also found this study by Mental Health America that places Utah #51 (or #1, depending on your point of view) for rates of depression and psychological stress.

Ann, regarding your comment on handing out Prozac like candy: When patients have legitimate Major Depressive Disorder (per DSM-IV TR), their symptoms improve about 60% of the time with standard SSRI and other modern antidepressant treatments. However, their symptoms improve about 50% of the time with a sugar-pill placebo. This tells us that depression is real, that the placebo effect is HUGE!, and that antidepressants can help out about 10% more people. Not all people fall neatly within DSM criteria, however, as I'm sure we have all experienced in our lives. Some people are not functional, or not optimally functional, for whatever reason, and they are treated with antidepressants and/or other psychoactive drugs because we don't have anything better to offer them. From my perspective, I only prescribe antidepressants, stimulants, etc. when patients meet strict criteria and only continue them if I see real, objectively verified improvement. Otherwise, I refer to behavioral or mental health specialists.

Moscar, I am not familiar with the rates of depression and antidepressant prescription in the Scandinavian countries. I think that a lot of us in the Secular Humanist-Atheist-Liberal world hold up Northern Europe as a "city on a hill," so to speak, of what can happen when people progress beyond supernatural delusions, petty selfishness, and obsessive materialist greed in social matters. I'd love to see what their rates are.

Krystal, I agree that many people in Utah are probably "depressed" or unhappy because they don't fit well into the one-size-fits-all mold that the church prescribes in regard to belief and behavior. I certainly was, and my wife is currently dealing with this issue. But without controlling for all confounding variables and following large numbers of people prospectively, we cannot make any claims of causation that lead from TSCC to high rates of depression.

More thoughts?

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Replies to This Discussion

I certainly don't vouch for the integrity or competency of all medical doctors. One of my mentors, a child cancer specialist, used to drill into us the idea that all other doctors are "trying to kill your patient."

Still, I trust in the reality of clinical depression and the efficacy of modern pharmaceutical treatments over placebo when used appropriately. Depression is a bio-psycho-social disorder, however, and needs bio-psycho-social treatment. Bio = medication, psycho = talk therapy, and social = social support and validation.
Before I get to the heart of a comment, I would like to remind people that the placebo effect -- although it is used as a "proving ground" against the medicine in question -- is not a villain. The placebo effect actually shows that the human brain -- given the right instructions -- can remarkably begin to change itself. This is a big problem for drug companies, though, who can't "sell" the brain's ingenuity. However, what pharma researchers are beginning to do is work with the science known about the placebo effect to make a comprehensive package. For example, if a drug has a base effectiveness of x, but we know that through advertising, people can learn to expect (thus activating a placebo effect) of y, then the total benefit can be x + y. The problem with placebo effects, again, comes to an ethics of sale. If effect y (the placebo effect) is much greater than effect x (the actual effect of the drug), then is it ethical to sell the drug?

NOW, on to the main topic of discussion. This survey about anti-depressant use (not the one about depressive episodes, so I can't really comment about that) has actually made the rounds throughout believing and nonbelieving LDS circles. Generally, there are a few conclusions that have been made each time. 1) High anti-depressant use is a sign that the legal system works and that people are getting the help they need. It is not indicative that Utah is necessarily "more depressed" (especially when Utah tops lists for "happiest state" as well. See: http://economix.blogs.nytimes.com/2009/03/10/the-happiest-states-of... ). 2) Anti-depressant use represents the "drug of choice" for Utahns (and particularly Mormons). This shouldn't be surprising, because Mormons don't have the breadth of options available for "drugs of choice" -- everything else is banned via word of wisdom or teaching of the church. 3) If we are talking about "clinical depression," then clinical depression has a genetic component. So it COULD BE that Utah has higher levels of depression (although this survey doesn't give us that information...rather, it gives information about anti-depressant use)...and it not be due to anything explicitly Mormon, except that Utah Mormons are a close-knit community genetically speaking. That being said, this predisposition is just a predisposition...so generally, environmental events can activate it.
Excellent points, Andrew. Interesting that Utah could be both the "happiest" and the "most depressed" state at the same time. Mormonism may make the extremes more extreme, or it may actually function well as a way of making a large number of people happy with life. My family certainly loves it.
My favorite analogy is The Matrix (or Plato's Cave, if you prefer). Cypher, the bad guy, wanted to be reinserted into the Matrix because he preferred the blissful ignorance to the harsh reality of being unplugged. A lot of Mormons that I know well are truly happy in their profound ignorance. Trying to unplug them has been one of the worst experiences of my life. As much as we can see through the lies of TSCC, we are deluding ourselves (how's that for irony?) if we cannot admit that some TBMs (a lot of TBMs, IMO) are truly happy in their ignorant and deluded state. A lot of them are not happy, I am sure. I have no idea what the percentages would be.
Sorry for using jargon/acronyms:
TBM: True Believing Mormon, True Blue Mormon, Totally Blind Mormon, etc.
TSCC: "The So-Called Church"
IMO: In my opinion (and IMHO: In my humble opinion)

Yes, drunken ignorance Mormon-style may be a false-yet-satisfying happiness for some, but for them to sober up is then equal to the worst hangover/withdrawal ever. Freeing your mind is like kicking the habit for good.
The gentic predisposition could be a factor for sure, but I've lived in several states and known Mormons in several states, and in all honesty I've known more Mormon women (not men) on antidepressants in each state than non-mormon women. The Mormons in others states simply don't have the inbreeding that the Utah Mormons do.

I realize this is an anecdote so not statistically effective, but I knew ( and was good friends with ) a Mormon woman in Michigan who had...you know I don't even remember. My last count was 19 bio kids and 2 from her husbands previous marriage before he became Mormon. I think there were a couple more after that. I had'nt spoken to her for a couple of years. The whole time I had known her she always looked like she was going to drop. She had been exhausted for years. I don't think she even had time to be depressed. I got a call one day and she had found out she was pregnant again. A couple of days later she drover her car...purposely..into a semi truck. 2days later...yes 2 days...her husband married her sister and began breeding her to death. This is 1 of many many stories I could cite.
I do think Mormonism is a cause of depression for women. Sure, part of it might be genetic, but a lot of it is'nt.
Any of them that can't afford private health care are usually victims of the county mental health clinics. I say "victim" because I was tossed around in that system for years. They ask you what is going on in your life right at that moment, and then shove a pill at you. I was diagnosed as "clinically depressed" for years by a variety of psych doctors, and guess what ? I did not have psych problems. I had Temporal Lobe Epilepsy and my depression was from nobody figuring that out until I saw a private shrink this year in NY. I was on anti-depressants, anti-psychotics, sleeping pills.... all of which gave me the symptoms the doctors were trying to medicate away based on a 15 minute interview always about current family affairs. When I did get to talk about what was really bothering me..the TLE symptoms, they were ignored and "depression" got slapped on my charts.

That's many doctors covering many states, all in the county mental health system. The symptoms of TLE are pretty specific. I was diagnosed on 15 minute interviews with no testing whatsoever. ( except one time in Michigan but they still did'nt catch it.) I was depressed by the TLE symptoms I could'nt control, NOT "clinical depression". I really think the mental health system is so swamped they don't even take the time in cases of medicaid patients in particular to give a real diagnosis. I was on the drug carousel from hell when I did'nt need any of them. The Mormons I knew in Utah were all poor and in the same system.

Something needs to be done to make sure that the people being given anti-depressants are actually clinically depressed. I really don't think the majority of them are. The people I knew all had plenty to be depressed about. The drugs are being used to tolerate their problems instead of dealing with their problems. It's an avoidance tool and one the doctors easily provide and I think that is particularly the case in Utah. If anti-depressants were not doled out so easily, perhaps they would have to deal with the root of their unhappiness and maybe we'd have a few more atheists among us. ( but this applies to all people in the sytem ) yes I know ..the funding just isnt there. That's what I was always told. The DSM criteria needs to be overhauled, that or doctors need to start paying attention to it. Many of the doctors in Utah being Mormon..I just have to wonder if that does'nt play into this somehow. Seriously, what are these doctors going to tell their clients ? " Well if you are unhappy with your life, change it ? Go against what your husband wants ?" I doubt it. They'd be run out of Utah on a rail. The safest thing for doctors in Utah to do..simply so they can keep their practice is...prescribe a pill.

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