From Anxiety to Depression and Back Again

/ Author:  / Reviewed by: Joseph V. Madia, MD

Poet W.H Auden dubbed the post-World War II nuclear era the "age of anxiety." Indeed, at the time, anxiety disorders were the most commonly diagnosed mental illnesses.

However, by the 1990s, American psychiatry was "Listening to Prozac," and instead of obsessing about angst, it focused its attention on depression. Now, a new article in the The Milbank Quarterly by sociologist Allan Horwitz, dean for the social and behavioral sciences at Rutgers University, suggests anxiety could rise again.

Although conditions involving anxiety and depression are currently divided into several different disorders in psychiatry's Diagnostic and Statistical Manual of Mental Disorders, most people who suffer from depression also experience anxiety and vice versa. As a result, prevailing psychological theories and pharmaceutical industry marketing have tended to determine which diagnosis predominates.

"In the 1950s and '60s, anxiety was the core nonpsychotic condition for psychodynamic theory [that] was by far the dominant theory," said Horwitz, referring to therapy based on the ideas of Sigmund Freud. At the same time, drug companies were beginning to market drugs known as tranquilizers, including Miltown, Valium and Librium, as anxiety treatments.

By the 1980s, however, a backlash against both Freud and tranquilizers had developed, Horwitz said, and a media panic over the idea of addiction to tranquilizers captivated the public.

"In my opinion, this is a bad rap," said Edward Shorter, professor of the history of medicine and psychiatry at the University of Toronto. While benzodiazepine drugs such as Valium can be addictive, research shows the majority of people who become addicted to them are users of multiple other drugs as well, not people using them medically.

Rather than fight the growing stigma attached to anxiety drugs, however, manufacturers started heavily advertising antidepressants such as Elavil (amitriptyline). Then, in 1987, they introduced Prozac and marketed it and similar drugs as fixing the "brain imbalance" associated with depression.

In 1962, 12 million people had been diagnosed with anxiety disorders, and just 4 million were labeled depressed. But by 1975, 18 million people were diagnosed as depressed, compared with just 13 million with anxiety disorders. According to Horwitz, by 2000, 10 percent of the population of the U.S. received antidepressant prescriptions.

But history is again repeating itself, with somewhat of a backlash against antidepressants. "You are starting to see some reaction against them," Horwitz said, noting the recent controversy over whether antidepressants are even superior to placebo.

"There's also the corruption of psychiatrists collaborating with the pharmaceutical industry, the suppression of negative results, the suppression of things like the data on these drugs raising suicidal ideation," Horowitz said. Consequently, he predicts a shift back to a focus on anxiety, with the panic over tranquilizers largely forgotten.

"This makes physicians sound like idiots," Shorter said. "But they are very much the prey of drug company advertising. Whatever diagnosis is being advertised will end up as the diagnosis given clinically. That is the reality."

Health Behavior News Service

Reviewed by: 
Review Date: 
September 15, 2010