'Manufacturing Depression': Are Doctors Overprescribing Antidepressants to the Tune of $10 Billion a Year for Drug Companies?

Is depression manufactured? Two decades after the introduction of antidepressants, it’s become commonplace to assume that our sadness can be explained in terms of a disease called depression. The National Institute of Mental Health estimates more than 14 million Americans suffer from major depression every year and more than three million suffer from minor depression. Some 30 million Americans take antidepressants at a cost of over $10 billion a year.

My next guest argues while depression can be debilitating, it’s also been largely manufactured by doctors and drug companies as a medical condition with a biological cause that can be treated with prescription medication. Psychotherapist and writer Gary Greenberg participated in a clinical trial for antidepressant medication and found that more often than not the drugs failed to outperform placebos. His latest book is a scientific, medical, historical and cultural exploration of the antidepressant revolution here in the United States. It’s called Manufacturing Depression: The Secret History of a Modern Disease.

AMY GOODMAN: Tell us about the trial you went through.

Gary Greenberg: I enrolled in a trial at Mass General Hospital, intending, actually, to enroll in a trial for minor depression. But the tests that I took showed that I had major depression. And the trial was a trial of fish oil versus placebo, which meant that I was taking omega-3 fatty acids or a placebo, I didn’t know which.

AG: And what happened?

GG: What happened was that I returned to Mass General every other week for two months, and I was given the same battery of tests over and over again. And as the time went on, I appeared to be getting better on the tests that were being used to measure my depression. At the end of the trial, I asked if I could be told if I was on the placebo or the drug, and they told me no, but since it was the next to the last day of the trial, I still had some pills left. I sent them off to a lab, and it turned out I was on the placebo.

AG: What did you think?

GG: I thought that was really interesting. And I thought that it was more interesting that the doctors really assumed that I was on the drug. The way I know that is because after the trial was over, they offered me what’s called an open label trial, where I would get what I knew to be, in this case, fish oil, which is standard for clinical trials. If they think the subject was on the drug, they offer them the drug after the trial is over, even if they have no way of knowing.

AG: So, talk about your overall thesis in this book, Manufacturing Depression, two decades after exactly what?

GG: It’s two decades after Prozac was introduced, which saw an explosion of two things: one of them is sales of antidepressants in the Prozac generation, and the other is the rates of diagnosis of depression. And in the book, what I’m trying to do is to show how these two things go together and how, in many respects, the drugs came first, and how this was something that has grown historically. For at least 150 years we’ve been heading in this direction.

And basically what the book is about is why it even makes sense at this point for people who are unhappy to even think about the possibility that they have a mental illness. And in the book, I’m mostly interested to say that our concern probably shouldn’t be so much with the drugs themselves as the meaning that we have for why we’re taking the drugs, which I believe shapes our response to the drugs, and that what really we should be paying attention to is how easily people are diagnosed with mental illnesses, as opposed to given other explanations or opportunities for themselves to explain why they might be suffering.