The Double Standard on Depression

One of Eli Lilly’s key objectives, when they were marketing Prozac in the early 1990s was to get employers to reimburse for anti-depressants. Some leaders of the National Association of Manufacturers had expressed reluctance to underwrite “mental health benefits” in the Clinton Health Plan; they had to be convinced that a workforce on Prozac would be in their interests. Lilly funded a study by an MIT economist that Tipper Gore and Fred Goodwin of the National Institute on Mental Health ballyhooed at a press conference (also funded by Lilly) and Daniel Goleman publicized in the New York Times in December ’94 (without mentioning Lilly). “Depression Costs Put at $43 Billion,” said the headline. “The cost of days lost from work is about $11.7 billion,” Goleman reported, “and impairment from the symptoms while people continue on the job costs $12.1 billion more.” Add to this “earnings lost to suicide… about $7.5 billion.”

To make Prozac a blockbuster, Lilly spread the word that clinical depression was abroad in the land. They enlisted the help of the NIMH (whose top officers retire and get hired by the drug companies the way Pentagon brass get hired by the arms makers) and the National Mental Health Association (a non-profit funded by pharmaceutical companies) and freelance opportunists like Dr. Peter Kramer (author of Listening to Prozac), and Dr. Douglas Jacobs, creator of National Depression Screening Day. The ultimate goal of all these promoters was to get the American people to take a simplistic test for depression -a test designed to convince almost any honest adult that he or she is a candidate for Prozac. The test is based on criteria set forth in the Diagnostic and Statistic Manual, the so-called “bible” of the American Psychiatric Association. The drug companies influenced the drafting of the DSM so that the definition of depression would apply to as many people as possible -i.e., would maximize the potential customers. See “The Drafting of DSM-III,” a great book by Kirk and Kutchens.

This is how doctors are taught to detect depression: “The presence of depressed mood (5) or loss of interest (6) and at least four other symptoms over a two-week period is required for the diagnosis of a major depressive episode. 1) Changes in appetite and weight 2) Disturbed sleep 3) Motor retardation or agitation 4) Fatigue and loss of energy 5) Depressed or irritable mood 6) Loss of interest or pleasure in usual activities. 7) Feelings of worthlessness, self-reproach, excessive guilt 8) Suicidal thinking or attempts 9) Difficulty thinking or concentrating.

Is there a single adult in America who could not qualify for a diagnosis of depression? The criteria are vague and all-embracing. Losing weight? You’re depressed. Gaining weight? You’re depressed. Sleeping too little? You’re depressed. Sleeping too much? You’re depressed. Going too slow? You’re depressed. Going too fast? You’re depressed…

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