Antidepressants: Treatment for bad marriages?

The assumption that people struggling with their marriages or other domestic issues are suffering from depression is not supported by the way depression is defined medically, said Jonathan M. Metzl, Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society at Vanderbilt and the study's lead author. The study, conducted using a Midwestern medical center's records from 1980 to 2000, appears in the current issue of the Yale Journal of Biology and Medicine

Notably, Metzl said, the time period of analysis followed a 1974 decision that removed the term "homosexuality" from the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard reference book of psychiatric illnesses.

"As it became less acceptable to overtly diagnose homosexuality, it became increasingly acceptable to diagnose threats to female-male relationships as conditions that required psychiatric intervention," Metzl said. "Doctors increasingly responded by prescribing antidepressants when patients came to the office describing problems with heterosexual love and its discontents."

The researchers argue that this pattern became particularly prominent after the advent of Prozac and other SSRI antidepressants and widespread pharmaceutical advertising in the 1980s and 1990s.

20 years of records

In their review of archived psychiatrist-dictated patient charts from the expansive hospital system, the researchers discovered a pattern.

"In the charts we analyzed, the pressures of attaining or maintaining heterosexual relationships functioned as common modes for describing depressive symptoms," Metzl said.

But women and men with marriage woes "have little connection to the current DSM criteria for depression and much more to do with ways that society thinks that men and women should behave," Metzl said. "And yet these cultural pressures seemed to go a long way in determining whether psychiatrists diagnosed depression or prescribed antidepressants."

"In many ways, the 1974 decision was a major step forward," Metzl said. "But as we show, implicit gender still functioned in the exam room, and our analysis suggests that psychiatry still has work to do in that regard."

Metzl conducted the study with Sara McClelland, assistant professor of women's studies and psychology at the University of Michigan, and Erin Bergner, a Ph.D. candidate in sociology at Vanderbilt.

The paper, "Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center," was published June 27 in the Yale Journal of Biology and Medicine.