For once we are 1er, Long live France !
Your wife left you, your dog is cheating on you, and you have a tax audit on your ass, no problem! The pharmaceutical industry has thought of you!
Update 12.11.2015 : We have been dethroned in terms of antidepressant treatments by the Icelanders, but the problem persists...
The French take the world record for antidepressants. The performance requirement has long been put forward to explain this phenomenon. It leaves room for questions about the roles of the pharmaceutical industry and the medical community. in France, three times more tranquillizers and antidepressants than our European neighbors. And this overconsumption increases every year. Hundreds of thousands of people, in difficult periods of life but not suffering from any psychiatric disorder, are prescribed these drugs for long periods, without being warned of their side effects or benefiting from regular monitoring.
France now has 5 million consumers of antidepressants. Prozac and its affiliates literally boosted this market, leaving behind the first molecules manufactured in the late 1950s (see box, p. 61). This new generation of antidepressants is no more effective than the previous ones but it has the advantage of generating fewer side effects. The success of antidepressants cannot, however, be explained by this single argument put forward by the laboratories, and which is also highly contested...
World consumption record
Would France be hit by an epidemic of depression? Nothing is less sure. The need for care for this disorder remains poorly assessed. Fixing the threshold of pathology has here, in fact, something arbitrary, so difficult is it to distinguish normal homeostatic reactions of sadness from depressive states as such. Epidemiological studies for this pathology are therefore few, difficult to implement and often discussed. Their results vary greatly from one country to another, and even from one region to another. According to the studies and the diagnostic criteria used, the prevalence of the rate of depression in France in the general population varies from 5,8 to 11,9% (1).
France nevertheless holds the world record for the consumption of psychotropic drugs (antidepressants, hypnotics, anxiolytics). The turnover of antidepressants was multiplied by 6,7 between 1980 and 2001. This trend would be on the rise, despite frequent disputes about the efficacy and harmlessness of some of these drugs. Thus, for example, the risk of suicide associated with antidepressants in children, made public in recent months. The public authorities are more generally concerned about the proliferation of medically unjustified prescriptions and the chronicization of treatments.
How to explain this French specificity of the consumption of antidepressants? Few in-depth analyses, but various common-sense arguments are invoked here and there. We first spoke of the deleterious effects of “social malaise”, of the improvement in the diagnosis of depression. We mentioned the fragility of the new generations: in the past, people were more accepting of their condition as suffering beings. They put their fatigue, their depression, their anxiety on the account of a difficult "human condition" (2). Some think that antidepressants are only the relay of another psychostimulant, alcohol, of which France is a big fan. As for Social Security, long compelled to blind reimbursement of drugs, it would have left bad habits to settle. For others, this French passion for antidepressants would be due to cultural elements such as the poverty of collective regulations, the weak support of the group, the inadequacies of social mediation. Today, most specialists admit the joint action of all these factors.
Pharmaceutical companies accused?
In fact, the consumption of antidepressants informs us about the individual and society as a whole and it is in this respect that it is of real interest to researchers in the human sciences. The sociologist Alain Ehrenberg, in a book which is now a reference (La Fatigue d'être soi. Dépression et société, Odile Jacob, 1998), explains the success of depression as the result of a shift from guilt to responsibility. The consumption of antidepressants then appears as a response to a feeling of helplessness, a means of achieving the performance injunction of a society where everything becomes potentially achievable.
Other analysts put forward the powerful capitalist logic of pharmaceutical laboratories, of which the individual would be a victim. The recent work of a journalist, a former executive in the pharmaceutical industry (3), reveals the dubious practices of an industry whose interests conflict with the principles of public health: the extraordinary success of antidepressants would be based on more or less clinical trials. less trafficked, the development of marketing strategies, an almost absolute control of medical information... There would be deception on the goods and manipulation, which had already been shown, with supporting surveys, the English psychiatrist David Healy.
Still, the conspiracy thesis does not hold up... Good connoisseurs of the field such as the former executive of the pharmaceutical industry Philippe Pignarre or the psychiatrist Edouard Zarifian, if they do not deny the involvement of the laboratories, analyze this "mode" of depression as the product of a more complex system, involving the pharmaceutical industry, society, but also the academic psychiatric and medical circles.
Disrupted health
Concerning the latter, the critics fuse: "Faced with the lowering of the limit between the normal and the pathological, which opens new markets for prescription, the opinion leaders (in the world of psychiatry) remain silent, thus contributing to accrediting the reference to the somatic medical model as the only model for psychiatry”, denounces E. Zarifian in Le Prix du bien-être. Psychotropics and society (Odile Jacob, 1996).
The “objectifying” drift embodied in the American manual for the classification of mental disorders (DSM) would encounter too little resistance from French psychiatrists. The DSM would tend to oversimplify the diagnosis of depression: five criteria evolving for at least two weeks are necessary on a list of nine symptoms to establish the diagnosis of depression. This pathology, the treatment of which is 75% prescribed by general practitioners, is gradually imposing itself in people's minds as a reality of the same type as infectious diseases. P. Pignarre speaks of “mental body” to designate this representation of psychic disorders, while the doctor proposes with a reflex gesture “the offer of depression to a patient who asks for help”.
In this dialectic where the disease and the drug co-produce and maintain each other, the depressive illness finally becomes "what cures under antidepressant (4)": if the antidepressant relieves you, it is therefore that you are depressed, we are told. in essence the new medicine of the soul. The extension of the use of antidepressants? whose indications now concern obsessive disorders, anxiety-depression, social phobias and post-traumatic stress? contributes in turn to dissolving the concept of depression, to drowning out its meaning.
The very notion of “health”, which extends to well-being and performance, is being turned upside down. "Medicine no longer has the sole objective of curing you but of making you live as well as possible for as long as possible with your pathology", analyzes Claude Le Pen, economist and adviser to the unions of pharmaceutical laboratories (5). We can indeed fear with him that the doctor and the drugs will then become “tutors, who smooth our life entirely”. Will medicine be the social regulator of tomorrow?
A flourishing market
The class of antidepressants appeared in the late 1950s, and has since seen the development of several series of different molecules. Tricyclic antidepressants (Laroxyl and Tofranil) were first discovered in 1957, followed in 1962 by monoamine oxidase inhibitors (Marsilid).
The undesirable effects of these two categories of drugs have prompted the search for new molecules with identical therapeutic efficacy. Thus, in 1987, a new class of antidepressants appeared: serotonin reuptake inhibitors (SSRIs), of which Prozac had long been the leader. These so-called serotoninergic antidepressants owe their success to their virtual absence of side effects and toxicity (particularly at the cardiac level), for an action similar to the parent molecules. Their indications have also been extended to pathologies other than depression, such as obsessive-compulsive disorders.
Sales of antidepressants have multiplied by 6,7 since 1980, when SSRIs were put on the market. The substitution on the prescription of the oldest products (imipramines) by these new molecules (SSRIs) with reduced side effects and therefore sold more expensively, would explain this explosion in turnover. Added to this is the increase in volumes prescribed for cases of depression stricto sensu (specific depressive episode) and the extension of these prescriptions to other indications such as anxiety disorders, phobias, etc.
Studies also show a significant lengthening of treatment times and a tendency towards chronicity, which also raises the question of dependence on these products.
NOTES
[1] V. Bellamy (coord.), “Mental disorders and representations of mental health: first results of the “Mental health in the general population” survey”, Studies and results, no. 347, Drees, October 2004.
[2] Interview with C. Le Pen, dossier “Why the French love antidepressants so much”, Le Monde 2, December 11, 2004.
[3] G. Hugnet, Antidepressants: the great intoxication. What 5 million patients don't yet know, Le Cherche Midi, 2004.
[4] L. Roure, Depression, Ellipse, 1999.
[5] Interview with C. Le Pen, op. cit.
source: http://www.scienceshumaines.com/-0 [...] 14006.html
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