The DSM-III +U0027s neutral stance toward the etiology of mental disorders meant that advocates of all treatment orientations were supposed to find equal value in its symptom-based classification system. In practice, however, pharmaceutical companies were best able to capitalize on the DSM+U0027s focus on symptoms, which allowed them to broadly construe states of intense sadness as depressive disorder and thus to vastly increase the potential market for antidepressant medication. Several other developments helped propel an explosive growth in the use of these drugs, including the emergence of the selective serotonin reuptake inhibitors (SSRIs) in the late 1980s, the spread of managed care throughout the U.S. health care system in the 1990s, and the approval of direct-to-consumer (DTC) advertisements in 1997. This chapter considers the relationship between the DSM revolution and the roughly contemporaneous exponential growth of drug treatments for depression.
For thousands of years, physicians have used medications to treat depression. Beginning with the ancient Greeks and Romans, doctors commonly prescribed purgative and laxative medicines that induced vomiting and evacuation of the bowels.1Richard Napier, the seventeenth-century physician mentioned in chapter 3, typically used sedatives and analgesics, as well as laxatives and purging concoctions, in his practice.2He prescribed opium for about 10% of his melancholic patients. By the nineteenth century opium, morphine, and other alkaloids had become common treatments for depression, joined by the barbiturate sedatives during the early twentieth century.3