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The Age of Distracti-pression

A grotesque computer-generated graphic covered the front page of the Sunday Styles section —nothing but bottles of glossy, rainbow-colored pills. It alerted readers to a piece on page 5, where Casey Schwartz mused on why sales of Adderall, Prozac, and other mood-altering pills have risen during the past two years of relative isolation. Her reporting consists mainly of comments from contacts, none of whom she presses for more info than they want to provide.

The burgeoning legal cannabis industry undoubtedly cut into pharmaceutical sales in 2020-21, but Schwartz doesn’t ask whether the drug companies engaged in anti-pot lobbying. Maybe she assumes that in a nation this unhappy there’s room for two, three, many forms of Soma. Either she’s naive or investigative reporting is not her thing. Big Pharma is still funding lobbyists to constrain the development of cannabis-based medicines and the distribution of recreational marijuana. Sales of Prozac and Adderall don’t keep rising thanks to word of mouth. The drug companies go to great lengths to induce MDs to push their mind-altering synthetics —and to fend off competition. 

Schwartz herself is a journo-pusher. Her first quote is from a nurse with two small children who says, “I should have gone back on medication sooner in the pandemic than I did.” According to Schwartz the nurse “weaned herself off in time for her first pregnancy” —implying, but not saying it was easy. When postpartum depression set in, she went to a talk therapist who taught mindfulness and meditation.

“After a complicated second birth,” Schwartz goes on, “she decided she needed more than just talk… She turned to Prozac again. Now, she said, ‘I’m a different person’.” 

Schwartz informs us that “millions of Americans... started or restarted psychiatric medication during Covid’s long and dreary run” but can’t be more specific because, she states matter-of-factly, “Tracking exactly which pills Americans are swallowing these days is difficult because much of this information is privately held.

Why should that be acceptable to a reporter? If you have the prestige of the NY Times behind you, why not contact Shire LLC and Eli Lilly and request sales data? Let them explain why the extent of Adderall and Prozac use in the US is “proprietary information” and can’t be revealed to US, the people. What legal code are they hiding behind? What gives drug companies the right to conceal financial and scientific data that has implications for our public health? Remind us of how the system works 

Ms. Schwartz gleans data from secondary sources. “In 2019, the Centers for Disease Control and Prevention estimated that 15.8 percent of American adults took prescription pills for mental health. What’s new is this: Almost a quarter of Americans over the age of 18 are now medicated for one or more of these conditions.”

Express Scripts, a pharmacy benefits manager, confirms that the use of meds for depression, anxiety and ADHD has risen in different ways since the pandemic began. Antidepressant sales rose 8.7 percent rate from 2019 to 2021.

“Since 2017, there has been a 41 percent increase in antidepressant use for the teenagers included in the Express Scripts data (which consists of roughly 19 million people.) For this same 13- to 19-year-old bracket, in the first two years of the pandemic, there was a 17.3 percent change in anxiety medications. It had been a 9.3 percent rate of change between 2017 and 2019.”

A positive thinker, Schwartz speculates that “Part of the uptick could be explained by the fact that, stuck at home, people finally had time to seek out the health care they had been delaying.” (Eli Lilly explained Prozac-induced suicides by saying the drug doesn’t induce the ideation, it gives users the energy to act.) 

Lilly was granted approval to market Prozac on December 29, 1987, although serious red flags had been raised when the FDA examined the results of the clinical trials (meaning research Lilly paid for with grants to investigators at various universities and private research institutions). The clinical trials of Prozac excluded suicidal patients, children, and elderly adults --although once FDA approval is granted, the drug can be prescribed for anyone of any age. Approval was based, ultimately, on three studies indicating that fluoxetine relieved some symptoms of depression more effectively than a placebo, and in the face of nine studies indicating no positive effect. Only 63 patients were on fluoxetine for a period of more than two years; therefore, nobody knows the long-term effects .

The psychiatrist who ballyhooed Prozac most prominently in the early years was Peter Kramer, author of ‘Listening to Prozac,’ a best-seller that Schwartz calls his “landmark 1993 book that helped crystallize the cultural moment.” What Kramer’s book crystallized was blockbuster sales for Eli Lilly. In the late ’90s. as serious adverse effects reported, ranging from loss of sex drive to bizarre violent flip-outs, Kramer tried to curb his enthusiasm. Schwartz represents him as a doctor who was always “asking careful questions about who should use Prozac and why.” But that was an obvious act. He was a pusher extraordinaire. 

Schwartz devotes exactly two sentences to the possible adverse effects of SSRIs: “Debates rage on the efficacy and safety of antidepressants. In a recent article in The Nation, the writer P.E. Moskowitz, echoing a longstanding concern of some prominent skeptics, points out that antidepressants are much more difficult to get off than advertised and that the chemical-imbalance theory of depression on which it all rests has never been proved.” 

Having met her fair-and-balanced quotient, she jumps into a discussion of Adderall --a stimulant drug marketed by Shire in 1996 that would eventually replace Ritalin as the best-selling pharmaceutical upper. In the 1980s Ritalin (methylphenidate HCl), a strong stimulant manufactured by Ciba-Geigy, was pushed successfully in US schools. Its use was justified by a pharmacological false claim: it supposedly had a “paradoxical effect” on the young, calming them down instead of getting them wired. In fact Ritalin had the classic effect of speed on people of all ages --focusing one’s attention on whatever is directly in front of one’s face (and causing loss of appetite, increasing jitters and insomnia). The apparent effect was calming, and overworked teachers and parents accepted the known risks. 

As adolescents left high school and lost access to Ritalin, many turned to cocaine —an expensive and dangerous alternative. Others found ways to score Ritalin and functioned satisfactorily. It was safer and cheaper than coke, a performance enhancer if used occasionally. The drug companies no longer needed the cockamamie “paradoxical effect” to sell stimulant drugs to children, and references to it dwindled in the medical literature. 

When it came time to name the combination of four amphetamine salts that Shire had developed to compete with Ritalin, a clever wordsmith realized they were marketing not a chemical compound but a diagnosis that millions of adults now qualified for: Attention Deficit Disorder. The marketers’ battle cry became the name of the drug: “ADD for All!” 

Casey Schwartz informs us that “Within 10 years, more than nine million Adderall prescriptions were written. And from 2006 to 2016, use of prescription stimulants doubled... Among Americans ages 20 to 44, numbers of ADHD medications went up 7 percent from 2017 to 2019, but they increased by 16.7 percent from 2019 to 2021. New rules lifted the requirement that doctors see patients in person in order to prescribe them certain controlled substances, including Adderall.

“Newly minted telehealth companies like Cerebral, which was founded in 2020, provided customers with stimulant prescriptions after a 30-minute, online-only consultation.”

Schwartz ends her piece on the same upbeat note she opened with. Dr. Tina Nguyen, an LA psychiatrist, has a teenage patient for whom she prescribes “Prozac, Concerta, Gabapentin and Ritalin for when the Concerta wears off... Her mother, Ellie, isn’t concerned about the implications of the medications long-term. She herself is used to the idea of taking prescription pills over years, even decades.

“ ‘I have been on Lexapro and Prozac for as long as I can remember,’ she said. ‘I started taking Prozac as a senior in college, and I’m turning 50 this year. I would not be able to function without it’.”

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