An Easier Pill to Swallow?

Prozac, Ritalin, Xanax, Adderall, Zoloft. Thanks to creative advertising campaigns, prolific prescriptions and extended media coverage, psychiatric drugs like these have become household names.

Since the introduction of Prozac, an antidepressant, in 1987, and a proliferation of prescription treatments for attention deficit hyperactivity disorder (ADHD) in the early 1990s, psychiatric prescription drugs have swept the nation. These drugs are taken by millions every day, and the University is no exception to this phenomenon.

"In the 1980s, about 5 percent of the students we saw were taking psychiatric drugs," says Dr. Doris Iarovici, a psychiatrist at Counseling and Psychological Services. "Last year it was about 30 percent." The increase is even more pronounced considering that more students are visiting services like CAPS, which sees about 1,000 students a year. "There has been a dramatic increase in students coming in for counseling at college counseling centers," Iarovici says. "The numbers are up, we're not sure why."

	Related: • The Potential for Abuse

Jim Clack, director of CAPS, suspects that in addition to the students CAPS sees, there are many students who are currently taking psychiatric drugs who do not visit counseling. "Ninety percent of all medications are not prescribed by psychiatrists," he says. "It's not just college students, it's the whole American population."

To deal with the increasing demand for counselors at Duke, specifically for those who can prescribe drugs, CAPS hired a third psychiatrist two years ago. "The trend we see reflects the trends of the country as a whole and other colleges; it's not unique to Duke," Iarovici says.

Psychiatric prescription drugs, which are used to treat a variety of behavioral, emotional and mental disorders, are nothing new to this generation. Ritalin, a central nervous system stimulant and one of the most common drugs used to treat ADHD, reached its peak prescription rate in the early 1990s, when most of today's college students were still in elementary school. According to a report in the Journal of the American Medical Association, the number of people aged 15 to 19 taking medication to treat ADHD has increased by 311 percent.

Dr. Timothy Strauman, professor of psychology, attributes the increases partly to a change in disease patterns. "The age of onset of depression is much younger now than it was 20 to 30 years ago," he says.

Dr. Allan Chrisman, assistant clinical professor of psychiatry and a practicing child psychiatrist, agrees and adds that the changes are affecting younger generations in other ways as well.

"We have evidence that the onset of depression intergenerationally is happening earlier and is more varied," Chrisman says. "There is a greater vulnerability to these disorders in this generation."

Chrisman notes that modern life and its stresses may be the cause, and that this generation is exposed to the disorders earlier and may have a greater awareness of them.

"At Duke, there's a lot of pressure to excel, there's an emphasis on work and academic performance, sometimes to the exclusion of self-care," Iarovici says. "Duke is an intense place."

Even if they do not suffer from a disorder personally, more and more students are familiar with the disorders, their terminology and the drugs used to treat them.

"In our generation, prescription drugs are more accepted. Prescription drugs have been more a part of our vocabulary than our parents'." says sophomore Anisha Sundarraj who knows a few people who take psychiatric drugs. "I'd say the mentality of our parents is more towards 'buck up and deal with it'... We've been taught to be open to the idea that they're might be something chemically imbalanced."

Talk of these drugs has made it into the classroom as well. "I teach education classes, and I used to say in my classes that ADD was the diagnosis of the '90s," says Emma Swain, director of the Office of Services for Students with Disabilities. "It was very much in view, on TV and such, and some people saw the drugs as an end-all be-all, that if you take the drugs the problems go away. They do not. In addition to drugs, students need to do more to learn to live with this."

But whether or not the drugs alone can adequately treat a disorder, there is no question that advancements in drug technology over the past few decades have changed the face of mental health treatment.

"Without a doubt, a major change in treating people was the introduction of Prozac," Chrisman says.

Clack concurs, explaining that Prozac was the first widespread psychiatric drug that allowed users to continue to function with few changes to their daily routine. "Prozac is a psychiatric medication that works, is safe and has very few side effects," he says.

Although Prozac is used mainly to treat depression, psychiatrists have also learned a lot about treating anxiety disorders in the past few years, and the newer medicines are very helpful, Iarovici says. The top five drugs she prescribes are Zoloft, Prozac, Celexa, Effexor and Wellbutrin.

"It's easier for people to take the medicines than it was 15 years ago," Clack says. "There have been a lot of newer agents." He notes that the newer drugs help people to study better while the old ones had side effects that hampered studying.

The prevalence of such drugs is not without controversy. Some see the drugs as an inadequate solution to complicated problems, while others worry about over-diagnoses and over-prescribing, especially with ADHD.

"One problem with antidepressants is when people see them as a solution to a problem when they may not be," Strauman says. "Some people are put on antidepressants when another type of treatment would be more appropriate, or are put on an inaccurate dosage."

Iarovici sees a range of attitudes concerning drugs among the students she treats. "In some cases I wish I could have convinced a student to get psychotherapy. Sometimes I feel students want a quick fix," Iarovici says. "Sometimes there's someone who could really benefit from medication. Sometimes students are self-medicating with alcohol or drugs.

"We also see a fair number of eating disorders, and usually treatment will be a combination of therapy and medications," she continues. "Eating disorders are one area where some people are reluctant to address some of the issues and would rather just take an antidepressant. Some people would rather just address the depression component than the eating problem."

Part of the reluctance of some students to take medication lies in a stigma surrounding psychiatric drugs that has not completely disappeared even as awareness increases.

"This generation of students has a greater degree of familiarity with the drugs," Chrisman says. "I don't know that the stigma associated with them is gone."

Some students are indifferent about the presence of such drugs on campus, while others see them as well accepted.

"I think people here understand that mental health issues are just another type of issues people deal with, and it's not something to look down upon," senior Reechik Chatterjee says. "Students of our age know other people who take those different types of prescription drugs. These are normal people, no different than any one else. I don't think that mental health issues affect the way people interact."

Strauman sees positive changes in people's perceptions of psychiatric drugs, partly as a result of wide marketing campaigns and increased visibility. "I am certainly convinced that the use of medications like antidepressants and stimulants to treat ADHD is perceived as more respectable now than 10 to 20 years ago," he says. "With the availability of the drugs and reduced stigma, there are not only more choices for treatment, but people are more likely to take it in stride."

Iarovici agrees that the stigma is becoming less prevalent. "I would imagine that it is more comfortable for this generation to seek help from medications in general," she says. "We've come to know the biology behind emotional problems in the last 20 years."

She adds that CAPS prescriptions are kept confidential. "We don't report it to the University," she says. "The only way the University would know is if a student told the dean or signed a release. It's an individual choice."

But perhaps the most important consideration facing students looking to treat psychiatric disorders is the effectiveness of the drugs.

"Some students take the drugs and find them helpful, while some students don't want to take the drugs at all," Swain says. "These drugs have been around for a while now. I think in some respects, some of these drugs allow students to pursue an education who before would not have been able to."

Drugs used to treat ADHD can help students to focus and improve academic performance. But stimulant medication also has the potential for abuse (see sidebar).

"There is a very very small subset of students who come in and ask for medications inappropriately--who are unwilling to look at other aspects of their lives to change," Iarovici says.

Drugs that treat depression and anxiety disorders alleviate the symptoms and allow sufferers to function on an everyday basis. Overall, they can allow people who before might have been crippled by these disorders to lead normal lives.

"I think that for people suffering from depression and anxiety disorders, the medications make their experience in college a lot more pleasant," Iarovici says.

Chrisman agrees. "I think they enhance the ability for people to do better, they improve academic performance, they improve the ability to do the material, to attend classes. Outside of the classroom they can enhance the social experience, and help personal self-esteem."