Ok but this isn't really true. The country with the most anti-depressant intake is Iceland, the US is around second or third place, yet the other countries in the "top ten" of antidepressant usage per capita are almost all european nations. The USA isn't an outlier, but I guess we really can't escape the "do americans really, really do X?" even when it is trivially easy to verify.
The funny thing is that the reason Americans know the names of their medications is almost the exact same reason people seem to think the USA are always some sort of outlier; they hear about it more in the media! Branding for drugs is much more emphasized in the US.
In fact, the US[0] and New Zealand are the only countries were drug advertising like we see in the US are even legal. This absolutely will have an affect on perception
Great point. Another thought: prescriptions are often a healthcare provider's sole tool. They can't fix structural societal woes or make you exercise, eat healthy, pursue CBT with a therapist, etc. But taking a daily pill is a reachable stepping stone for many patients.
Yeah, antidepressants are way more complicated, they have more side effects, and have to be monitored carefully to not make the underlying issues that caused the patient to take them worse. Suicidal thoughts plus antidepressants that give you energy can give you the motivation to go through it. And despite not being categorized as addictive you can't stop taking them without wrecking your mental health until your body readjusts. If you don't refill your Rx of antidepressants your doctor will be notified and reach out to you because stopping has such pronounced effects.
While at the same time despite being a controlled substance because they're supposedly so addictive people with ADHD forget to take adderall and with normal use you don't take it every day.
We got this this shit so unbelievably backwards because we haven't shook the puritanical bullshit of "oh no someone might experience euphoria if they go out of their way to abuse it." Like bro, people with real medical issues shouldn't suffer because of this crap. If everyone who is buying cocaine from their dealer switched to medically supervised stimulants we would be unquestionably better off.
> While at the same time despite being a controlled substance because they're supposedly so addictive people with ADHD forget to take adderall and with normal use you don't take it every day.
This is incorrect: Normal use of stimulant medication is to take it regularly every day.
We also have evidence from studies showing that the brain adapts to consistent dosing in order to counter some of the damaging oxidative effects of amphetamine. Inconsistent dosing could undermine this adaptation and does not mirror the dosing protocol used in studies to determine long term safety. Sporadic dosing is also known to cause sensitization effects in studies, which can sensitize people to the negative side effects of a drug or exaggerate cravings.
Some people do take medication holidays as recommended by doctors, but even those should be done on a pre-determined schedule.
People get themselves into trouble when they start treating Adderall like an ad-hoc drug that they can take more or less of depending on how they feel that day or how much work they need to get done. This not only leaves the brain in a constant and unpredictable state of flux, it creates an association between “I need to do work” and “I need more Adderall”. Patients who go down this path often end up escalating doses, playing games with saving up pills to take more, or trying to talk their prescribers into extra dosages beyond what they need. It ultimately ends with higher tolerance and reduce effectiveness.
> If you don't refill your Rx of antidepressants your doctor will be notified and reach out to you because stopping has such pronounced effects.
This also isn’t true. There are many medications with withdrawal symptoms far worse than antidepressants. Some drugs can be potentially fatal if discontinued abruptly. Pharmacies don’t generally hunt down doctors when a patient doesn’t get a refill.
Antidepressant withdrawal (without taper) can be difficult for some, but so can withdrawing from Adderall. There are entire subreddits acting as support groups for people tapering down Adderall and trying to get back to feeling normal after taking Adderall for years.
Stimulants are definitely habit-forming and have a high abuse potential. Let’s not downplay it.
> Normal use of stimulant medication is to take it regularly every day.
Yeah, that doesn't really track with the fact that non-extended release lasts about 6 hours and extended release lasts about 8. Every single doctor I have ever been to has told me to take it as needed and try to not take it if possible so I don't form a habit and build a tolerance. Doing this I've managed to stay on the same exact dose for years. I would be willing to chalk it up to doctor doing it wrong but I see people whose job is specifically to oversee ADHD patients' medication and they say the same thing.
It's technically possible to be under it's effects for your entire waking hours and overlap to smooth the comedown in the middle but it's never prescribed this way so you'll always be in a state of flux.
> and does not mirror the dosing protocol used in studies to determine long term safety [...] it creates an association between “I need to do work” and “I need more Adderall”
Both of these are absolutely true which is why the studies are silly since nobody takes stimulants this way. And I absolutely have that association but it leads me to take less not more. If I want to spend the day hyperfixating on a new video game I can and just skip it. I can wait until understimulation and executive dysfunction actually impacts me.
I know it's not what you mean but I still think "this medication is incredibly habit forming so make sure to take it habitually" is really funny.
> Pharmacies don’t generally hunt down doctors when a patient doesn’t get a refill.
It was my insurance company actually. They called my doctor to see if I was supposed to still be taking it, told him to reach out, and then called me and sent a whole informational pamphlet about why it's important to take it regularly.
My doctor suggests that I don't take my adhd meds when I don't need it (school/work), and has had no objection for me to only take them on weekdays. That would absolutely not be the case for antideps.
I don't disagree, but stats are hard to come by for other types of psychiatric drug. I'd be interested to know if international studies have done on the subject, because it might very well not be an ideal "proxy" for general drug usage!
But I also personally think that adderall has less side effects and better/smoother withdrawals. SSRIs and other antidepressants usually have a heavier impact on the brain too.
Now I don't doubt that Adderall is probably over prescribed, but I think that it is better to look at entire families of drugs to compensate for differences between markets.
Iceland and the Scandinavian countries have, let's say, "weather-related" reasons for their depressions. They are introvert societies with the highest percentage of single-person households.
The reason for the US being close to them could be the high prescription culture and the social aggression inherent in everyday US life, masked behind curteous words, customer-oriented interaction and polished looks.
OK but I don't think chalking it up to 'weather-related reason' is entirely accurate either. That may make up a portion of it [1] but it doesn't make up all of it [2]. And I agree that the US has a high prescription culture, but you could argue too that this is an artifact of having an exceptional health care system by most metrics. Mental health disorders are complex with a multitude of causes and it's rather reductive to say that they're due to "the social aggression inherent in US life".
I mean sure, if you are being as charitable as possible with Scandinavia while also being as uncharitable to the US (with pretty insane stereotypes about american society), you will always find a way to conclude that "america bad, nordics good". But what's the point ? Can I also use tired, extremely hyperbolic stereotypes about Scandinavia?
(Funny though that you actually say that everyday life is masked behind courteous words in the US, which is one of the those widespread stereotypes about... Scandinavia and nordic countries in general.)
What was that about Swedes not even sharing meals with visitors, and eating in front of them while the visitor sits at the dinner table looking at them eat? Or Denmark kicking out all of their syrian refugees after they have lived there for years, kids included, to send them back to a warzone? See that explains the antidepressant intake!
Most of the US is significantly south of much of continental Europe (not just Scandinavia), as a point of comparison. We (broadly) experience longer days in the winter than Europeans.
GP is talking about winter sunlight, not year-round numbers. (Longer summer days don't help seasonal affective disorder.) Stockholm sees about 6 hours of daylight at winter solstice, while Seattle sees 8.25.
And Seattle is sort of cherry-picked -- it's one of the northern-most cities in the continental US, representing 1.2% of the US population (including the full metro area). LA sees 9.75 hours of daylight on the solstice. Honolulu sees 10.75 hours.
The US population-weighted centroid is approximately Missouri[1], which sees 9.5 hours of daylight on the solstice -- more than 50% more than Stockholm.
The funny thing is that the reason Americans know the names of their medications is almost the exact same reason people seem to think the USA are always some sort of outlier; they hear about it more in the media! Branding for drugs is much more emphasized in the US.