Salt Lake City -- Doctors here have for years
talked about the widespread use of antidepressants in the state. But
there was no hard evidence until a national study that tracked drug
prescriptions came to an unexpected conclusion:
Antidepressant drugs are prescribed in Utah more often than in any other
state, at a rate nearly twice the national average.
Utah's high usage was cited by one of the study's authors as the most
surprising finding to emerge from the data. The study was released last
summer and updated in January.
Other states with high antidepressant use were Maine and Oregon. Utah's
rate of antidepressant use was twice the rate of California and nearly
three times the rates in New York and New Jersey, the study showed.
Few here question the veracity of the study, which was a tabulation of
prescription orders, said Dr. Curtis Canning, president of the Utah
Psychiatric Assn. But trying to understand the "why" has puzzled many,
he said.
"The one true answer is we don't know," said Canning, who has a private
practice in Logan. "I have some hunches.
"In Mormondom, there is a social expectation--particularly among the
females--to put on a mask, say 'Yes' to everything that comes at her and
hide the misery and pain. I call it the 'Mother of Zion' syndrome. You
are supposed to be perfect because Mrs. Smith across the street can do
it and she has three more kids than you and her hair is always in place.
I think the cultural issue is very real. There is the expectation that
you should be happy, and if you're not happy, you're failing."
The study did not break down drug use by sex. But according to
statistics from the National Institute of Mental Health, about twice as
many women as men suffer from depressive disorders.
Discussion of the issue inevitably falls along Utah's traditional fault
lines. Some suggest that Utah's unique Mormon culture--70% of the
state's population belongs to the church--requires perfection and the
public presentation of a happy face, whatever may be happening
privately. The argument goes that women in the Church of Jesus Christ of
Latter-day Saints are beset by particular pressures and are not
encouraged to acknowledge their struggles.
Helen Wright, 71, of Taylorsville, Utah, has been using various
antidepressant drugs for 20 years and says she's never had problems
getting prescriptions.
"Look around, you can easily find people who take them. I think it's the
cultural environment," said Wright, whose three grown children also take
antidepressants. "Most men here would just as soon their wives take
pills than bother to delve into the problems, and maybe find out they
might have something to do with the problems."
Not so, says Fred M. Riley, commissioner of LDS Family Services. The
church maintains 10 offices in Utah staffed with licensed counselors.
Riley said he has heard the various explanations of the study but he
dismisses suggestions that the Mormon religion imposes any expectation
of perfection.
"The fact that the church has established family services shows they
care about the emotional side of members," Riley said. "In fact, the LDS
population is more open to getting help and getting things fixed."
Utah's large families--the biggest in the nation according to the 2000
Census--are often cited as a contributing factor to depression, again,
largely among women. Others call the "harried housewife" explanation the
stuff of urban legend.
"The question I would raise is whether there is any evidence that a high
level of social demand predicts depression," said Amanda Barusch, a
professor in the graduate school of social work at the University of
Utah. "Who says that having six kids will make you depressed? There's no
evidence in the literature that shows that. Stress is not the same as
depression."
The study was conducted by Express Scripts Inc., a St. Louis-based
pharmacy benefits management company, which tracked prescriptions of 24
drug types in about 2 million people selected at random from its 48
million members. Those studied were enrolled in privately managed
health-care programs, and the information gleaned from the study is
intended for use by HMOs. Medicare and Medicaid recipients were not
included in the study.
Utah also leads the nation in the use of narcotic painkillers such as
codeine and morphine-based drugs, the study found, and is ranked seventh
in total prescriptions overall. Kentucky ranked first.
The study was the first national survey that examined regional trends in
drug use. The information in the "Prescription Atlas," as the study is
called, has made little impact here since its publication.
No official interviewed in Utah's mental health or substance abuse
agencies had much notion as to what the study says about Utah's mental
health.
"To be honest with you, I don't have a clue," said Randy Bachman,
director of the Utah Division of Mental Health. Bachman was not in his
current job when the study was released. While the results speak for
themselves, he added, interpreting why antidepressants are in high use
is a thorny matter.
State officials say the study's results could indicate that this is an
enlightened society in which depression and mental illness are
destigmatized. In such a social climate, they say, more people are
willing to seek help and, eventually, are prescribed drugs.
"That's certainly a plausible explanation," said Emily Cox of Express
Scripts, one of the five authors of the study. "There's a lot of
inferences being drawn from this. We can't say if there is a higher
probability for depression or depressive symptoms. You may have a
population that seeks care for less severe symptoms. You may have a
medical community that prescribes more readily."
Cindy Mann, who lives in Logan, said after 15 years of taking
antidepressants and not feeling better, she finally quit in July. Today
she encourages others to do likewise, but she's pessimistic.
"It's like Happy Valley here," she said, describing the Salt Lake
Valley. "It's a scary place sometimes. People don't talk about their
problems. Everything is always rosy. That's how we got ourselves into
this mess--we're good at ignoring things."
The LA Times February 2, 2002