Hacker News Reader

Comment by StevePerkins | Hacker News Reader

The headline is a bit confusing. At first glance it might seem to say that 1/3 of Americans take anti-depressants. What it's actually trying to say is that 1/3 of Americans take prescription drugs that have depression as a possible side effect.

Even that seems bizarre to me. What is the percentage of Americans who take prescription drugs... period? I'm a middle-aged man, and (knock on wood!) still haven't come down with any chronic conditions requiring medication. So I would probably assume that no more than 1/3 of Americans take ongoing prescription drugs at all.

Which means I'd have to presume that pretty much all drugs have depression as a possible side effect.

View on HN

Just from a bit of googling:

>Researchers find that nearly 70 percent of Americans are on at least one prescription drug, and more than half receive at least two prescriptions, reports CBS Atlanta.

>Researchers from the Mayo Clinic, a non-profit medical and research center, report that antibiotics, antidepressants and painkiller opioids are the most common prescriptions given to Americans.

https://www.cbsnews.com/news/study-shows-70-percent-of-ameri...

Since antibiotics have depression as a potential side effect that boosts the number.

Wonder if that includes birth control? A gender breakdown would be good.

There's an exhibition at the British Museum (http://www.pharmacopoeia-art.net/articles/in-sickness-and-in...) that shows how many prescription pills people take over their lifetime. It's striking how many more pills women take (mostly due to birth control obviously).

Cool to know it's still there. One of the most remarkable things I've ever seen at a museum

of course we live a lot longer than people used to on average. would be interesting to measure how much is from treating problems along the way, vs more healthy hygiene vs childhood survival from sickness.

Birth Control would explain most of the of the OP, wouldn't it?

Much of the rest can be explained by that it's much safer (for the pharma company) to declare an extremely mild/rare side effect than to not declare it. "Depression is a side effect" != "most people who take this drug are depressed"

The vast majority of these drugs seem to be pain killers (unless you count birth control).

It seems to me, given that, the depression side effect is probably related to the following sequence of events:

1) painkillers are given to patients in lieu of actual treatment (you can fix anything with painkillers. With a very low short-term cost and you may get lucky and get a low total cost too (ie. problem disappears by itself))

2) body "adapts" to painkillers, and they, very slowly, become less effective over time

And, boom, there comes your depression.

As a middle aged man I assume you're not on birth control, a prescription drug whose side effects can include depression. I would not be surprised to find that prescription birth control makes up the lion's share of the third of the adults counted in the article.

Based on my family's anecdotes it seems even discounting even the contraceptive angle, hormonal BC seems to be the crude implement to treating a host of female health issues we don't under stand very well.

Note, copper IUDs (which are non-hormonal) have worked well for all the women I know on it. I’m sure it’s not a panacea, but it’s effective, cheap, and essentially zero maintenance beyond verifying it’s still there.

I believe in some states in the US you can even get the state to pay the cost.

IUDs are associated with a lot of nasty high impact, low frequency side effects.

Birth control is a lot more predictable, especially now that dosages are lower.

Hormonal birth control may be more predictable, but it predictably has bad side effects (acne, weight gain, depression, and a host of other symptoms I’ve forgotten). There are also people where it straight up doesn’t work—one of the women to which I’m referring had two kids on hormonal birth control before connecting the dots and switching.

Overall, everyone has their own birth control needs. Most of the evidence I’ve seen has led me to prompt people having issues to consider the copper IUD because it does seem to work very well (when those complications you mentioned don’t show). A surprising number of people have misconceptions about insertion, periods, hormones, and efficacy, so I’m always happy to increase the amount of power people have over their own uterus by making them aware of their choices.

A certain, cynical part of my brain believes the reason the pill is popular is that there are many, many incentives to encourage people to go a route that returns recurring revenue, not helping women find what works best for them. It seems to be pretty common to simply prescribe the pill when people ask for birth control.

No matter what else is going on, Jimmy always wears his hat when he goes out. The only procedures guaranteed to permanently work as birth control 100% of the time are hysterectomy and bilateral orchidectomy. When you multiply failure rates together, they get smaller.

Don't ignore your inner cynic. Medicine is not the only industry trying to force everyone to a subscription model in lieu of one-time expenses.

What? No. LARCs FTW. Since 2009, ACOG guidelines state they are the first-line option for birth control.

The impact, even of a uterine perforation, is not that high (and the frequency is also lower than you suggest).

tl;dr, the above is FUD.

When you ask doctors what birth control they use IUDs come out pretty high.

www.contraceptionjournal.org/article/S0010-7824%2815%2900072-4/pdf

Cheers!

No doubt contraceptives are a part, but they are actually taken by a small minority of people. They are only applicable to relatively young females, those capable of having children. Younger children and older women aren't much of a market. Depending on what ages you want to pick, the applicable population is probably less than 1/4 the total, with a smaller subset of that actually taking.

A quick googling says that 28% of women of "reproductive age" use the pill, which by my math is about 14% of women overall and 7% of the total population.

What math are you using? By my understanding, women are able to reproduce for around or close to half their lives.

First result[1] I found while googling defines women of reproductive age as 15-49, and claims that group makes up 24% of the overall population, which would line up with my intuition.

[1] PDF http://www.who.int/management/UsingDataToImproveServiceDeliv...

EDIT: Ah, reread your comment, looks like your math lines up with mine, just misunderstood. Thought you meant 7% of the population were women of reproductive age, not that 7% of the population were women of reproductive age on the pill.

Although it also makes me wonder if a sizable percentage of women outside reproductive age are on the pill. Either because they are fertile longer than average, or as treatment for other conditions.

Hormone Replacement Therapy is similar.

As I understand it while doing the initial research any time someone says they experienced something on a medication it has to be listed as a side-effect, which is why you end up with "Side Effects may include: naseau, diziness, heartburn, stubbed toes, and spontaneous pregnancy" Given any sort of decent sample size, someone is going to be experiencing depression while under pretty much any medication.

If that's the case, I wish the information would include percentage of cases. 90% side effect of severe depression and 2% side effect of dry mouth is a very different medication than 90% dry mouth and 2% severe depression.

Unfortunately, the typical patient doesn't interpret probabilities very well. Still, lists of side effects often use language like "very rarely".

First, frequency != probability. What negative outcome is expected by sharing the actual values though?

To the extent that probability means anything in the real world, it means frequency. The domain of the frequency is the rub.

Yes, and correlation doesn't imply causation except when it does.

Say, a patient doesn't take an important drug because the 0.001% chance of death seems too large, or alternatively they are falsely comforted by a seemingly-small 1% chance of death.

I don't get it, "seems to0 large" and "seemingly-small" according to who? It seems like you are against the patient doing their own cost-benefit analysis and instead someone else needs to be doing it for them. Who and on what basis?

So, we can first infer that the patient isn't correctly taking the numbers under advisement because they use them inconsistently (e.g., they worry more about four things that are 1 in a million rather than one thing that's 1 in 10 thousand). The question of how to align the patients understanding and actions with what they would do if they had perfect knowledge and intelligence is of course fraught, but one way is to compare medical risks to other risks they understand more intuitively. It's a big topic.

Is that not the case in the US? Every prescription drug I take in the UK has them broken down by "Very common" (>1/10), "Common" (1/10 to 1/100), "Uncommon" (1/100 to 1/1000), "Rare" (1/1000 to 1/10000), "Very rare" (1/10000 to 1/100000), and "Frequency not known" (frequency cannot be estimated from the available data).

I don't think I've ever seen that in the US. Would be useful information to know, though, for sure.

I see that on my prescription brochures in the US.

If you get a tiny print information sheet it has that information somewhere. More conveniently, drugs.com has that information in the professional section of the side effects page.

The inconvenient aspect is that the number of listed side effects seem to inevitably be proportional to how long the drug has been around and how much it has been used and researched, so you also need to have a general idea of all of that if you are trying to figure out which of two drugs is likely to be safer. Also, if two (or more) drugs are commonly used together, the side effects of the combination can be listed on both drugs, even if one of the drugs is most likely primarily responsible.

they break it down into "common" and then various others.

the trick is that most of the ones on the tier immediately after common are actually in the common tier, but they may not have the severity necessary for a patient to report it.

example: chantix(https://en.wikipedia.org/wiki/Varenicline) patient reports ubiquitously report nightmares almost without exception, yet nightmares are listed as a rare side effect because the nightmares might not necessarily be severe enough to mention to a doctor or meet the clinical criteria for a side effect.

I have to imagine it's probably closer to 1/2 of people, maybe even a bit more, that take prescriptions. As people age they are much more likely to be taking some prescriptions , I imagine it's quite a large percentage of people over 60. Many women take prescription birth control. Even for people who aren't taking prescriptions long-term, there's probably a fairly large percent of people at any given time that are on some prescription antibiotic, pain killer, muscle relaxer, or some other short-term medication.

A lot of the middle-aged and over are on statins to control cholesterol. I think I started on them in my mid-40s. Various not very old, not very hefty friends are on diuretics for blood pressure.

Just running a quick back of the napkin, because I also think that seems high:

The CDC says that there were 117 million adults with chronic conditions in the US in 2012 and there are 100 million people over the age of 65, the majority of whom (I'm betting) have at least one prescription. Blood pressure medication, anti inflammatories for arthritis, steroids for skin/muscle/hormonal issues, and on and on. That's your third right there. The issues that come with chronic conditions also tend to be more systemic so their treatments are more likely to have impact on brain chemistry leading to depression. I couldn't find CDC stats for children but I'm willing to bet it'd bring the number of people taking prescriptions for chronic conditions to 125-150 million with all the asthma inhalers, ADHD medication, and so on that adolescents get.

Obviously not all of those people are taking a prescription year round and there is significant overlap but I think it's very feasible that two thirds of the country are on at least one prescription between all the chronic and acute conditions. Another thing to consider is that some doctors will write prescriptions for common over the counter medication.

- 59% of adults in 2012 take prescription drugs.

- 15% are taking 5 or more

- "One likely factor driving the increased use: obesity."

https://www.washingtonpost.com/news/to-your-health/wp/2015/1...

You are fortunate!

I’ve been on blood pressure control medication since I was 22 (thanks ancestors). As much as it sucks, having a stroke later in life sucks infinitely more.

Reply on news.ycombinator.com