Trends: From Anxiety to Depression and Back Again

Mar 25, 2010 By Maia Szalavitz

Poet W.H Auden dubbed the post-World War II nuclear era the “age of anxiety” and indeed, at the time, anxiety disorders were the most commonly diagnosed mental illnesses. Yet, by the 1990’s, American psychiatry was “Listening to Prozac” and instead of obsessing about angst, it focused its attention on depression.

Now, however, 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 are currently divided into several different disorders in psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM), 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 non-psychotic condition for psychodynamic theory which 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”— like 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 at the University of Toronto. While benzodiazepine drugs like Valium can be addictive, research shows that the vast 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 like 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 . According to Horwitz, by 2000, 10 percent of the American population received antidepressant prescriptions.
Recently, however, there has been somewhat of a backlash. “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.”

Explore further: Mood instability common to mental health disorders and associated with poor outcomes

More information: Horwitz AV. How an age of anxiety became an age of depression. The Milbank Quarterly 88(1), 2010.

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