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The White Noise

The White Noise

A hit of addiction and mental illness, chased by chemistry and culture.

Do we choose pain medication over anti-depressants?

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According to recent headlines, we might be poisoning ourselves and our kids with pain pills, yet we’re afraid to tell doctors we’re depressed.

Anti-depressants are the second most prescribed kind of medication in the U.S., and an estimated one in 10 Americans reports suffering from depression. This class of drugs has become about as common as table salt in American households, yet enough stigma (and fear of side effects) still exists to make patients feel uncomfortable telling their doctors if they're experiencing symptoms of depression. In a recent study, 23 percent of people polled said they kept their symptoms of depression a secret because they feared their doctors would prescribe anti-depressants. And in fact, disclosing depression might be more of a societal than personal problem, with anxieties that insurance premiums will rise or colleagues at work will find out.1

Is this such a thing to be ashamed of? Funny how chronic pain is acceptable, eliciting the most sympathetic of nods from acquaintances and colleagues alike, yet the equally chronic debilitation of depression is taboo. It makes me wonder: do we avoid treatment for chronic depression and instead overuse and abuse supposedly sensible, necessary pain pills to self medicate?

Do we subconsciously favor physical over mental pain?

The Problem With Choosing Physical Pain Pills

An op-ed in the Archives of Internal Medicine (subscription required) noted that little research has been done on long-term effects of opioids (a common type of prescribed pain pill), including the drugs' effects on patients with psychological disorders and depression. This is alarming when 30-50% of those taking opioids suffer from symptoms of depression and anxiety, and as seen above, many more are likely undiagnosed.2 Even when doctors flag a secondary problem, such as depression, in addition to chronic pain, the diagnosis can easily slip through the cracks, doctors tending to treat one disorder over the other. Plus, over time, those being treated for chronic pain need higher and higher doses of opioids to feel the same effects.

And do we need all these opioids? Accidental poisonings of children five years old and younger increased by 22% from 2001 to 2008, with most of these kids ingesting opiates like oxycodone and codeine.3 Researchers attributed this largely to higher amounts of prescription drugs in homes.

Though, regardless, we need to do a better job of locking up meds around kids, should doctors be more stringent on pain pill dissemination and more open to discussions on depression medication, where more treatment might be actually needed?

Or perhaps we’re our own worst enemies? Do we think we can conquer depression on our own? Do we simply think prescription pain meds are fine, non-problematic substances?

Someone certainly has her pills badly sorted.

1 Bell, Robert A., Franks, Peter, Duberstein, Paul R., Epstein, Ronald M., Feldman, Mitchell D., Garcia, Erik Fernandez y, Kravitz, Richard L. Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care. Ann Fam Med 2011 9: 439-446

2 Grady, Deborah, Berkowitz, Seth A., Katz, Michael H. Opioids for Chronic Pain. Arch Intern Med. 2011;171(16):1426-1427

3Bond, Randall G., Woodward, Randall W., Ho, Mona. The Growing Impact of Pediatric Pharmaceutical Poisoning. The Journal of Pediatrics 2011 07.042

The views expressed are those of the author and are not necessarily those of Scientific American.

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