No New Insights into Women and Depression

The National Alliance on Mental Illness (NAMI) got some grant money from Wyeth Pharmaceuticals to produce an updated brochure on Women and Depression. The result?

A publication that is largely information that’s been regurgitated time and time again (you can see many of the same topics in NIMH’s Women and Depression brochure), culled from a myriad of sources (sadly, not a single one of them attributed in the brochure, meant for consumers), reproducing little tidbits of facts long known, such as:

• An estimated one in eight women will experience depression in their lifetimes; twice the rate as men, regardless of race or ethnic background
• Middle-aged Hispanic women have the highest rate of depressive symptoms, followed by middle-aged African American women.
• Young Asian American women have the highest rate of younger groups and the 2nd highest rate of suicide among 15 to 24 year olds.
• American Indians and Alaska Native adolescents are the most likely to attempt suicide and die from it.

Interesting, if any of this were new data, but none of it is.

What the brochure really needed was a decent editor, because it’s full of nonsensical statements. Excuse me for shooting a few fish in a barrel, but we expect a higher standard from an organization like NAMI.

I picked a few of our favorites from the brochure, although there are many more to choose from. Let’s start with one of my favorites, What causes depression?

Researchers suspect that, rather than a single cause, many factors unique to women’s lives play a role in developing depression.

The section on “Causes” then goes on to talk about genetics, biology, psychosocial, victimization and poverty. Few of these factors are unique to women. Obviously women have similar genetic makeup as men and no research has implicated a female-specific gene as being the cause of depression in women. Same with the psychosocial — men have pessimistic thinking, low self-esteem and can worry a lot too. There’s been no research to show these kinds of factors are more significantly prevalent in women (except, perhaps, low self-esteem).

Victimization and poverty are really sub-topics under psychosocial, since they indeed deal with social aspects of living within a shared society. While poverty bias is prevalent in non-industrialized countries, it is on more equal footing in the U.S. and other industrialized countries. It’s likely that depression doesn’t discriminate when it comes to the incidence of depression amongst poor men and women.

Men have biology, too, of course, but women’s biology can indeed be more of a contributing factor to depression. Postpartum depression, for instance, is a very real and serious concern for many women after childbirth. Oddly, however, it is mentioned briefly only once in the entire brochure. This would’ve been an ideal opportunity to dispel many of the common misconceptions about this type of depression unique to women, but the brochure largely fails to do so.

Let’s see if the brochure presents a balanced picture about antidepressant medications (FYI, Wyeth is the maker of Effexor).

Selective serotonin reuptake inhibitors (SSRIs) are the most widely used antidepressants. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most popular antidepressants worldwide. They include venlafaxine (Effexor) and duloxetine (Cymbalta).

Bupropion (Wellbutrin) is a very popular antidepressant classified as a norepinephrine-dopamine reuptake inhibitor (NDRI).

[…]

Older agents, such as the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), are used rarely now as first-line treatment. Although TCAs are similar to SNRIs, they have higher rates of side effects. Their use is generally limited to cases where other antidepressants have failed. TCAs include amitriptyline (Elavil, Limbitrol) desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil) nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

Naturally I expected to find the myth that tricyclic antidepressants (TCAs) have more side effects than their modern counterparts, SSRIs and SNRIs. Notice, too, the very subtle bias introduced in the sentence — it mentioned only SNRIs, not SSRIs. Wyeth just so happens to make a SNRI, not an SSRI.

A more balanced review of the research literature shows that SSRIs, SNRIs, and tricyclic antidepressants all have side effects. The only question is what kind of side effects are more tolerable to you — not being able to perform sexually, or having a dry mouth? Of course, this is a simplistic reductionist argument I’m making on purpose (actual side effects vary widely), but it shows that data can be spun whatever way is most advantageous to the spinner.

In this case, the author (who is unnamed in the brochure) clumped tricyclic antidepressants with an entirely different class of antidepressants that is indeed rarely prescribed any longer. (They took pains to separate out different classes in the preceding paragraphs.) Then it repeated myths about TCAs which are popular, but largely untrue if taken out of context.

And last, but not least, let’s make sure people are confused about whether psychotherapy will be covered by one’s health insurance:

Private therapists usually accept only private insurance and some therapists don’t accept any health insurance.

Huh? Which is it? Do they accept only private insurance, or no insurance at all? The two seem directly contradictory, especially when they appear in the same sentence.

The truth is that most therapists accept a wide range of health insurance plans. A certain number of mental health outpatient visits are usually available at low-cost via your employer’s health insurance plan, requiring a small co-pay (usually between $20 – $50). Some plans limit the number of sessions to 12 before requiring additional authorization from the insurance plan.

By the wording of this sentence, the brochure seems to imply that seeing a private therapist is difficult to get payment for psychotherapy treatment. While indeed there may be some people who have such difficulty, some people also have difficulty getting a brand-name drug paid for by their health plan (especially if only generics are covered, as is increasingly becoming commonplace).

Read our news story about this brochure: Insights on
Download the NAMI brochure: Women and Depression (PDF)