A customer pops in to drop off a prescription for the antidepressant Zoloft.
“Do you guys have any?” she asks.
“We do, but we always need more,” an MU pharmacist says as she steps between the shelves to look.
With the federal Food and Drug Administration now calling for warning labels that spell out the increased suicide risk among young users, antidepressant use by children and teenagers is facing greater scrutiny than ever.
But the FDA’s call for “black box” warnings on prescriptions such as Luvox, Effexor and Paxil does not appear to be deterring use of antidepressants among students at MU, some of whom began using the drugs in their teens. At MU, the number of antidepressant prescriptions dispensed by University Pharmacy has more than doubled since 1997.
Zoloft, a well-advertised medication used to treat depression and social anxiety, has seen the greatest increase with 858 prescriptions filled in the 2003-04 academic year — an increase of nearly 100 percent from just two years prior.
Stephanie Bagby-Stone, a Student Health Center psychiatrist, is aware of the FDA recommendations issued after research found a 2 percent to 3 percent increase of suicidal thoughts in children younger than 18 using certain antidepressants.
She tells patients about the increased risk, but Bagby-Stone is not ready to concede that the latest research should be interpreted as a critique of the drugs’ overall effectiveness.
“One concern is that these warnings may limit medically appropriate access to some lifesaving medications,” she said. “Patients may not seek help due to the recent warnings, and others may just abruptly stop taking it. This can put seriously ill patients at risk.”
Susan Even, director of the Student Health Center, think untreated depression can be even more of a risk.
“I think that the possibility of helping someone with depression who could become more depressed and possibly harm themselves or become suicidal is very important,” Even said. “These individuals need very close follow-up, which is important always when you first start someone on medication.”
Thomas McSherry, an MU pharmacist, said younger patients should not be hesitant to try antidepressants but must always be aware of the signs of suicidal tendencies and remain closely monitored by their doctors.
If people do have suicidal tendencies, they should not go on the drugs unless they are under close observation by a physician, he said.
Off-campus pharmacists are also noticing an increase in use of antidepressants in youth.
“I have seen an increase over a period of time but not in the past six months,” said Dan Cornell, a pharmacist at Flow’s Pharmacy. “A lot of it, I think, has to do with advertising. People are more aware.”
The growing acceptance among young people of prescription drugs to treat anxiety and depression represents a cultural shift, McSherry said.
“Twenty to 25 years ago (using medication for depression or anxiety) was a sign of weakness,” he said. “People just didn’t seek treatment because they would be marked as crazy.”
Now, the stresses of daily college life make a little pink or green pill an increasingly attractive alternative, McSherry said.
According to a recent report in The New York Times, 80 percent of campuses in the United States have noted significant increases in serious psychological problems, including severe stress, depression, anxiety and panic attacks.
“You have got to consider that these kids are under a lot of pressure, especially with midterms coming up,” said McSherry, who has been taking Effexor and other similar antidepressants for 17 years.
On campus, many students seem to know at least one person who uses antidepressants.
“More students use antidepressants than you would think,” said MU senior Dan Huber, an English and art history major. “I don’t know if students are depressed or if they are using them as a crutch for other things that come into play.”
Huber, 22, said one of his friends is not very vocal about his use but does talk about it within their small group of friends. But even with the growing acceptance, the social stigma is still high. Several antidepressant users interviewed for this article declined to be identified, citing concern of embarrassment or public ridicule.
“Health issues, in general, are very private and personal things,” Bagby-Stone said. “It would be the case-by-case situation on whether talking publicly would give patients any additional stress or anxiety.”
These pressures and anxieties may be the main reasons why students seek psychiatric help and prescription medications. A Consumer Reports survey released in September said in 1995 that less than half of mental health patients surveyed received drug therapy.
By contrast, a similar survey this year said 80 percent of patients treated for anxiety and depression receive drug therapy.
McSherry, who has worked with pharmaceuticals for 25 years, thinks antidepressants have been underprescribed for years.
“The antidepressants are in vogue, and it’s not a bad thing,” he said. “It has helped a lot of people. People are able to go back to work and function in society better. They can save marriages. They can save families.”
Even agrees. She sees the increase as a sign of the advancement of mental health.
“Medication yields quicker results for students, and it means they don’t have to drop out for the semester,” she said. “Students should be using therapy as well, an additional and important component to medication.”
MU students are allowed to have up to four visits per semester to the Student Health Center without a co-payment. The campus Mental Health Services logs an estimated 42,000 visits by students each year.
“It’s a very positive thing that people are seeking help,” said Bagby-Stone, who has been working at Student Health for two years. “These medications can be lifesaving to many patients.”
Bagby-Stone suggested that increased use of the Student Health Center could be a contributor to the rise in student antidepressant use. More people know the signs and symptoms of depression and anxiety, and many have seen friends and families respond positively to antidepressants and therapy, she said.
Also, students in financial need can obtain a pharmacy assistance plan that provides discounts on drugs. According to McSherry, about 115 of the 125 students receiving that assistance — which is subsidized by pharmaceutical companies — are getting prescriptions filled for antidepressants.