National sales figures indicate that from 1998 to 2002, sales of anti-depressants increased 73% to more than $12 billion, while analeptics, drugs like Ritalin and Adderall that stimulate the central nervous system, increased 167%, according to IMS Health, a pharmaceutical information and consulting company. Even more distressing, physicians wrote more than 1 million prescriptions for Strattera, a nonstimulant treatment for attention deficit hyperactivity disorder, in its first six months on the market.

But something is very wrong here. The dramatic increase in the sale of these pharmaceuticals suggest that Americans are well on the way to becoming not only depressed, anxiety-ridden and incapable of the meaningful focus necessary to understand the world in which we live, but also on our way to becoming a drug-dependent nation.

Doping up kids

No one would deny that ADHD, depression and anxiety disorders afflict millions of Americans. But to what degree? Through a combination of pharmaceutical companies' increased marketing, quick diagnoses from physicians and a lack of proper referrals from doctors, we are simply inundating huge numbers of people with unprecedented amounts of medication.

The issue is all the more sensitive and heartrending when it comes to our children. According to the Archives of Pediatric and Adolescent Medicine, a study of 900,000 youths showed that the number of children taking psychiatric drugs more than doubled in one group and tripled in the two others for the decade ending 1996.

"Any time a child reads a little more slowly, we're talking learning disability and administering Ritalin, or any time a kid acts up a bit, instead of giving him detention, we're drugging him," says Dr. Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania School of Medicine. He adds, "These are definitely problems, in that it's expensive, it may not address the cause of the problem and I've never met a drug yet, including aspirin, that didn't have some side effects."

In other words, some pharmaceuticals create greater problems than they treat. In June, British drug officials, later endorsed by the U.S. Food and Drug Administration, warned physicians and consumers that GlaxoSmithKline's anti-depressant Paxil carries a substantial risk of prompting teenagers and children to consider suicide. Two months later, Wyeth warned doctors of the same risks in its Effexor. U.S. sales of both drugs totaled nearly $4 billion last year.

The driving force behind the surge is aggressive direct-to-consumer advertising, Caplan says. Following the relaxation of a 30-year drug marketing agreement in 1997, pharmaceutical companies have tripled their annual advertising to consumers, resulting in a 37% increase in sales of prescription stimulants for children. Also, roughly one-third of all adults have asked their doctor about a drug they saw advertised, according to the Kaiser Family Foundation.

And those doctors are quick to dole out prescriptions. According to the American Psychiatric Association, primary care physicians now write upward of 60% of anti-depressant prescriptions. Says Caplan, "I think [doctors are] just overwhelmed now with too much marketing, and it drives them toward too much prescribing."

Uniquely American

In fact, American consumers, mostly children, account for more than 90% of global consumption of such stimulants. "If we have four or five times the learning disability or depression or other neurotic illnesses that the Europeans do," Caplan says, "then either we got a really bad gene pool through immigration or we're overmedicating."

In either case, a crisis looms. The pharmaceutical companies, the FDA and Congress must confront this issue now, and the physicians' credo is an appropriate starting point: First, do no harm. That credo simply must take precedence over profit motives, casual prescriptions and expedient parenting.

Originally published on September 28, 2003