Paxil Americana

Whenever I return to the U.S., I’m always surprised by how many more people I know seem to be taking prescription antidepressant drugs.  The reason I’m surprised is that the circles I travel in aren’t full of depressed people; instead, I’m meeting people who seemed to be doing fine, but are now taking Paxil, Wellbutrin, or Zoloft.

Of course, the standard disclaimer applies — people who are depressed should get the help they need, etc. etc. But nowadays it seems that any American going through a tough phase is tempted to Zoloft themselves back into good cheer. Yale psychiatry researcher Charles Barber lays out the facts in the Washington Post:

The use of antidepressants in the United States has exploded in the past couple of decades, and drugs such as Prozac, Paxil and Zoloft, which didn’t even exist 20 years ago, are household names, almost household staples….

In 2006, an astonishing 227 million prescriptions for antidepressants were dispensed in the United States — up 30 million from 2002. Altogether the United States accounts for about two-thirds of the global market for antidepressants. Other proven and practical approaches to managing milder forms of depression, such as diet changes, exercise or cognitive behavioral therapy, haven’t gotten the attention they deserve in our high-tech zeal for the drugs.

The drugs are popular because they produce results.  But that’s doesn’t explain the staggering number of subscriptions:

The television ads make it seem so easy: An agonized man or woman stares listlessly into space or slumps on a bed or couch, holding their head in their hands. Then they take a pill and suddenly morph into a happily engaged and joyous being, back on the job or walking in a park, awash in sunshine, surrounded by grandchildren, a golden retriever nipping at their heels, while lush music plays in the background.

And with this, we find ourselves at a crossroad of cultural differentiation between the United States and Europe, or so we might think.  Europeans accept bad moods as a natural part of life and don’t immediately reach for a shiny new pill to suppress them (instead, they reach for time-tested favorites such as alcohol).  The distrust of mind-altering pharmaceuticals is part of the rhetoric of "authenticity" which Europeans cultivate.  Europeans are allowed to be themselves, we hear, while Americans willingly re-engineer even their brain chemistry — the irreducible essence of their beings — to conform to an ideal of superficial, commerce-friendly geniality.

My reaction to this is similar to my reaction to many another stereotype: there’s a kernel of truth, but not much more.  There’s clearly a cultural emphasis on displaying a bright mood in the U.S.  Let me invoke the critical cultural bellwether of bike stores.  My local bike store in Austin has a sign behind the counter saying "Be Happy – Be Nice – Be Cool."  In Duesseldorf, my local bike store’s website warns you that one of its employees is "often unfriendly and in a crappy mood."(g)* Not for nothing did an American write "How to Win Friends and Influence People."  Further, Europeans (especially northern ones) often strike Americans as being unusually ‘genuine’ and tolerant of mood swings and personal idiosyncrasies. 

But how wide is the alleged U.S.-European divide on personality manipulation?  European countries have very high numbers of mental health professionals per capita, after all, and in all European countries, the use of prescription anti-depressants has also been dramatically increasing, even among children.  European newspaper columnists have a problem with wolfing down a mass-produced hamburgers in 20 minutes, but ordinary Europeans certainly don’t, judging by the long lines you see at McDonald’s franchises over here.  And I suspect that pepping up your mood and performance by taking a simple pill which has few side-effects will probably prove just as tempting…

* This description is, of course, tongue-in-cheek.  The bike store, Rad Ab (g) in the Friedrichstrasse, is way cool.

7 thoughts on “Paxil Americana

  1. My thesis:
    The difference is well explained by comparing the efforts necessary to get these drugs.
    Which is great argument for more restrictive laws on trading pharmaceuticals as in most European countries.

    In the second place, there may be cultural difference, but not the one mentioned:
    Namely, the distrust in psychiatry as a whole.
    Many people over here seem to be very anxious about accepting professional help for mental problems.
    Moreover, getting the pills involves a lot of personal contact (e.g. to the doctor), which even makes it harder
    if one equals depressions with personal devaluation.
    One might say that many Europeans do not yet accept mental illnesses as illnesses, but take them to be character flaws.
    So the alleged cultural difference you cited would be just the compementary view on the same effect:
    Americans are then quicker at identifying an illness when there is none.


  2. My guess is that Americans love Prozac simply because antidepressants work better on Americans. This is for the following reasons:

    1. One main effect – maybe *the* main effect – of antidepressants is the placebo effect. A recent meta study came to the conclusion that “although the antidepressants were statistically superior to placebo they did not exceed the NICE criteria for a ‘clinically significant’ effect.” (Kirsch, Deacon et al. 2008)
    2. Now, as readers of the “Freakonomics” Column know, the placebo effect is increased if the subjects know about their pseudo-drug’s high price (“More Expense = Less Pain”)
    3. Americans usually have to pay ridiculous amounts of money for their SSRI drugs – Germans (and many Europeans) are lucky: your Krankenkasse will gladly pay for the stuff, and even if you have to pay for it yourself, medication is much, much cheaper in Europe as compared to the U.S.

    Adding up all these points, we can easily see that SSRI don’t work on Europeans – because they don’t have to pay for them. Voilá!


  3. The use of antidepressants in the United States has exploded in the past couple of decades, and drugs such as Prozac, Paxil and Zoloft, which didn’t even exist 20 years ago, are household names, almost household staples….

    The use of anti-biotics, transistors, and jet engines has also exploded over “the last couple of decades.” Should we be worried?


  4. “The use of anti-biotics, transistors, and jet engines has also exploded over “the last couple of decades.” Should we be worried?”

    Well, yes, Sebastian. There is considerable concern about two of those three issues I believe. The overuse of antibiotics allows bacteria to form immunities to new drugs and makes the job of the public health authorities in fighting disease much more difficult. A ‘good citizen’ should make a point of NOT using ‘anti-bacterial’ products whenever possible. And environmentalists are very concerned about the overuse of jet engines. The ‘cheap flights’ boom is impacting the planet according to these people. Good environmentalists compensate by flying as often as they ever did but staying at ‘green’ hotels. Not being a virtuous person I fly less than I did but stay in my ‘non-green’ home instead. 😉

    I personally view the idea of using a chemical crutch to feel better about things as a bad thing for myself. But had I used one of these things a rather nasty bout of depression I had a few years ago might have been shorter and shallower. On the other hand – I eventually solved the problems which caused the depression – using the crutch might have impeded that. Then again it might have made it easier, I don’t know.


  5. Well, yes, Sebastian. There is considerable concern about two of those three issues I believe.

    My point was rather this: Antidepressants, like the other things I mentioned, have only existed for a couple of decades. (And SSRI type antidepressants have only existed since the late eighties – due to their relatively benign and rare side-effects and their proven effectiveness, they have made antidepressant medicine really accessible for the first time.) Their widespread use may be going overboard. But over “the past couple of decades”? That’s simply because they weren’t around before.

    I should also say this: These drugs are life-savers. They don’t deserve to be maligned as “happy pills,” which unfortunately happens all too often.


  6. I thought that France was world champion in antidepressants consumption: I see now they are only European champion.
    @Boto von Ageduch: Psychotherapies are quickly gaining acceptance, even in Germany. As for antidepressants, it might be necessary to have some personal contact with a doctor to start taking them, but renewing the prescription is often done very easily, and I’ve heard often enough about people using the pills prescribed to a different member of the household when going through a rough patch…


  7. My name is Michael Smith and i would like to show you my personal experience with Paxil.

    I am 40 years old. Have been on Paxil for 5 years now. Please be careful if coming off, i started to wean myself with out doctors help couldnt afford it. I went from 20 mgs to 10 mgs for a month, then 10 mgs to 5 mgs for a month. Because the 20 mgs were way to strong took 20 for 5 years and was always on edge. After about 1 month on 10 felt a little better. I stopped for 7 days completly and man did I feel like shit man I didn’t want to leave the house , shop! I just started back on 5 mgs to get it back in my system. Who know what is the right amount you have to be the test subject on yourself!

    I have experienced some of these side effects-
    Headaches, tremors, emotional wreck, just the blah’s when I 1st started takin wasnt bad, cause I also way taken klonopin.

    I hope this information will be useful to others,
    Michael Smith


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