10.05.08

Anti-Depressant Nation

Sometimes a little healthy anxiety is a good thing.

UPDATE, Aug. 8: Back in October, in the heat of the meltdown's mad theater of finger-pointing, I added anti-depressants to gang of culprits in a speculative piece I wrote for the first week of The Daily Beast. At that time, it was—stunningly—difficult to nail down the actual number of people popping those mood-altering miracles. I believe that's because the drug companies don't want us to know how successful they've been at mainstreaming depression and creating brands around its amelioration.

But this week, a study on antidepressant use appeared, and shocked many. The research was done by the Columbia University Medical Center and the University of Pennsylvania, who analyzed data from nearly 20,000 individuals. The findings: Between 1996 and 2005, there was a "marked and broad expansion in antidepressant treatment," with the rate of the medicated population going from 5.8 percent to 10.12 percent. The total number was 27 million people back in 2005, which means today there could be 30 million or more people whose perceptions of reality are being seriously altered. Ironically, if risk distortion and pleasure seeking—neural consequences of these drugs—were partly culpable for the Great Recession, we might very well need these pleasure-seeking millions to start-up those turbines of consumer spending yet again.

Did Lilly help bring down Lehman? Has the marketing of depression been complicit in propelling us to the brink of one?

We've played the blame game with just about everyone else; traders, brokers, ratings agencies, and financial engineers have all done the national perp walk.

But virtually no attention has been paid to whether there was something amiss inside the fevered noggins of those who took on these mortgages, as well as those who created and collateralized them. There are millions of Americans on anti-depressants, and my theory is that many of them might have been medicated into taking on irrational levels of risk.

After all, 237 million prescriptions were written last year for anti-depressants, making them the most prescribed drugs in America. And ironically, the bailout bill is likely to bring out pharmaceutical bliss even more. Because one of the provisions tacked onto the final version is mental health parity, meaning that employers who offer coverage for mental health must offer the same benefits as for medical conditions—the same co-pay, deductible, visits covered.

Perhaps after a little research, the familiar “Do not operate heavy machine when taking this drug” could become “Do not apply for a home-equity loan when taking this drug.”

There are many who argue that anti-depressants got to #1 status because Big Pharma has spent hundreds of millions to create a nation of psychological hypochondriacs using canny marketing to blur the difference between serious depressive states and merely painful, Billie Holiday-like blues.

But what exactly would turn psychotropic drugs like Prozac and Paxil and Zoloft into a subplot in the subprime mess? It's the biochemistry. Those drugs are SSRIs—serotonin uptake inhibitors—and they spin their mood magic by elevating levels of serotonin in the brain. And serotonin is a neurotransmitter associated with behaviors that might contribute to the temptation of borrowing $501,000 on a $500,000 house.

When I asked Dr. Helen Fisher, a biological anthropologist who studies brain chemistry, if my hypothesis passes the expert smell test, she replied: "I wouldn't at all be surprised if people taking drugs that elevate their levels of serotonin—which blunt the emotions—make some dumb financial decisions. Our emotions evolved, at least in part, to help us monitor our actions. "

Eli Lilly's website offers a different take on what happens when you change the brain's perception of what's real and what isn't:

"Prozac is one of the world's most widely prescribed antidepressants; it has been prescribed for more than 54 million people worldwide. Chances are, someone you know is getting better because of it."

And chances are you also know someone who has a house they can't afford, possibly because of it, too. Christopher Lane, who wrote Shyness: How Normal Behavior Became a Sickness told me at first he was skeptical of my hypothesis. "But as I thought about it, it made sense that drugs could have numbed people to the risks involved—extra serotonin can create a false sense of well-being and present a misleading neural picture to the brain that may be substantially at variance with reality. This may interfere with rational processes."

And rational processes, at best, aren't even all that rational. We know from the emerging disciplines of neuroeconomics and behavioral economics that, at best, human beings aren't wired to act logically. As Dan Airely, author of Predictably Irrational says in his book, we are really far less rational than standard economic theory assumes.

This evolutionary irrationality can definitely be heightened by serotonin. People on the drugs are removed from the consequences of action, a real disconnection said Charles Barber, author of Comfortably Numb: How Psychiatry is Medicating a Nation. He told me, "There is a theme in the literature about disinhibition, a buffered sense of reality." Dr. Eric Hollander, who is a Professor of Psychiatry, and Director of Clinical Psychopharmacology at Mount Sinai School of Medicine — as well as a practicing psychiatrist — told me, "Without a doubt, SSRIs make people perceive less of a sense of threat, so they are more comfortable with risk."

When I asked him if he has seen patients on these drugs who take financial risks they shouldn't, he said that he sees impulse control problems all the time.

The psychology of bubbles has long fascinated psychologists and social observers, with Charles Mackay's Extraordinary Popular Delusions and the Madness of Crowds, published in 1841, being the foundational tract. But conventional analyses of mass behavior don't take into account what happens when drugs get shoved into the mix of the cultural particle accelerator.

Joel Weinberger, who is a Professor at the Derner Institute for Advanced Psychological Studies, Adelphi University, and an expert in unconscious processes, noted that the power of group-think which encourages people to take larger risks  was fully operational during the bubble. There were shows on TV like Flip This House. If you were on meds, you might very well have crossed the line into unhealthy risk-taking from the combination of all those social pressures.

And that's just anti-depressants. There is also an enormous, additional population that is on stimulants for ADD, ADHD, and other conditions. The drugs they take—like Ritalin—trigger elevated dopamine, which is a neurotransmitter like serotonin, and is associated with reward-seeking behavior and the search for novelty. Another possible culprit.

I could be wrong about this. And to be fair, some experts I spoke to weren't totally convinced. But there's more than enough to warrant some further investigation. The implications are vast if millions are truly walking around with a compromised ability to assess risk and perceive threats.

We hang on the shadings of the famous Consumer Confidence Index, but how much of it is drug-induced? Perhaps after a little research, the familiar "Do not operate heavy machine when taking this drug" could become "Do not apply for a home-equity loan when taking this drug."