Meds as Social Drugs?

Last Editorial Review: 1/31/2005

You may be normal but you might feel even better with medication. Antidepressants and anti-anxiety drugs are being prescribed in such a fashion that it's become known as "cosmetic psychopharmacology."

By Denise Mann
WebMD Feature

Reviewed By Brunilda Nazario

When Stacy, a New York City-based computer saleswoman, was at a recent business dinner, her newest client turned to her and said, "You are medicated, right?"

She smiled nervously, not sure of how to respond. (She is, in fact, taking medication for anxiety.) That's when he said, "Don't worry, we all are!" He pointed around the table, naming the antidepressants or anti-anxiety medications that each was taking, as if he were introducing them.

Years ago, the use of medication to treat psychiatric illness was reserved for those people with major disorders, but times are changing.

Some media reports suggest that antidepressants and anti-anxiety drugs are the new recreational drug of choice, and all you need is a prescription pad or access to someone with one.

From selective serotonin reuptake inhibitors, a class of antidepressants that includes Prozac and Zoloft, to anti-anxiety medications such as Xanax and Valium, to attention deficit hyperactivity disorder drugs that boost alertness such as Straterra and Provigil, medications that treat mood disorders and personality quirks are becoming socially acceptable.

The Onion, a satirical newspaper, recently parodied the trend in an article called "Pfizer Launches Zoloft For Everything" campaign.

The spoof read: "Zoloft is most commonly prescribed for the treatment of depression and anxiety disorders, but it would be ridiculous to limit such a multi-functional drug to these few uses," Pfizer spokesman Jon Pugh said. "We feel doctors need to stop asking their patients if anything is wrong and start asking if anything could be more right."

Cosmetic Psychopharmacology?

The term "cosmetic psychopharmacology" -- which was first coined in the late 1990s by Peter D Kramer, MD, a psychiatrist at Brown University in Providence, R.I., in his book Listening to Prozac -- gets tossed around when discussing use of medications for people with milder forms of mental illness.

Cosmetic psychopharmacology "refers to taking someone from one normal, but less desired or less socially rewarded state to another normal, but more desired or more socially rewarded state," Kramer tells WebMD. It does not refer to frivolous prescribing.

Kramer says he has not seen the evidence of trivial prescribing with antidepressants in recent years.

However, he says, "the evidence of harm by depression has gotten stronger, and we have seen more technical justification for prescribing medications for lower levels of illness."

"My sense is that there are a number of people who may not meet the full criteria for major depressive disorder but are still experiencing dysfunction in their lives, and in addition, they just don't experience pleasure in many different activities where they might have at one time," says Victor Reus, MD, professor of psychiatry at the University of California San Francisco.

And such people "can experience significant symptomatic improvement, feel better, or perform better with medication," he says. "Is that cosmetic? It's not taking a pill to feel better than well, it is trying to treat subclinical deficits and may enhance normal performance.

"I don't think they are taken recreationally, and most don't work in terms of taking them now or then. These are medications that you have to take on an ongoing basis to have any effect whatsoever," Reus says.

The one thing everyone agrees on is that medications are not a magic bullet.

"I understand the great temptation in that people imagine this is the 'quick fix' -- as in less pain, more gain," says New York psychoanalyst Gail Saltz, MD.

"There used to be [marijuana], then alcohol, then cocaine, and now there are Rx pads," she says. "The downside that people aren't made so aware of is that some of these anxiety drugs are truly addictive -- meaning that people have to keep taking increased amounts to get the same feeling and they can't stop without going through withdrawal."

Antidepressants aren't addictive, she says, but they do flatten a lot of people. "You don't feel depressed, but you don't feel joyful either," she says. "They close the amplitude of emotions, so there are no lows or highs. This is why antidepressants were historically reserved for people undergoing major depression.

"Even if it makes you feel 'better,' taking an antidepressant is a Band-Aid if you have not looked underneath," she says. "I am not against medication, but I don't give medication to someone who isn't also in therapy."

One of the problems with medicine today is fragmented care, she says. People may see a psychopharmacologist for medication every three months and a therapist or social worker weekly or every other week to talk through their issues, and some may see one and not the other.

Stacey agrees. "I take medication, but I am also in therapy," she says. "I felt better that night at dinner when I found out that everyone was on it, but I still want to stop taking it eventually. I don't see it as a long-term solution, but it is helping me function better in the interim as I seek out that long-term answer or strategy to my worries."

Published June 30, 2003.

SOURCES: Victor Reus, MD, professor of psychiatry, University of California, San Francisco. Peter D. Kramer, MD, psychiatrist, Brown University, Providence, R.I. Gail Saltz, MD, psychoanalyst, New York.

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