Are Women in America Over-Prescribed?

A Q&A with the author of Moody Bitches, a book about the drugs we're taking, the sleep we're missing, the sex we're not having, and what she thinks is really making us crazy.

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Photo by amazon.com

Women are moody, and that's actually a good thing, according to Julie Holland, author of the new book Moody Bitches. Holland argues that women's dynamic emotions are evolutionary survival tools developed to alert us when we're in danger, care for our family's needs, and overcome hardship by thriving in a group setting. She even says that many women's tendency to stay organized may stem from the time of hunters and gatherers, when women needed to remember the location of their last food source.

Yet, today, many women use medications to stabilize their constantly changing emotions. Twenty-three percent of women between the ages of 40 and 60 take antidepressants, while fewer than nine percent of men do, according to the CDC. "The increase in prescriptions for psychiatric medications, often by doctors in other specialties, is creating a new normal, encouraging more women to seek chemical assistance," Holland wrote in a recent New York Times op ed.

We asked Holland a few questions about women, their moods, and antidepressants:

What initially sparked your interest in the issue of overmedicating, specifically antidepressants?

When I started my practice 20 years ago, women came to me confused by their symptoms and unsure of what to do. They complained of difficulty getting back to sleep or agitation or tearfulness, but they didn’t quite know what was wrong. I helped them put a name to their symptoms and explained that there were medicines that could help. I needed to do more teaching about drug therapy back then, and a lot more hand holding. I would set aside the last 10 or 15 minutes of the hour-long initial consultation in order to quell the fears of people who were wary of taking something that would alter their brain chemistry.

These days, many new patients come to me sure that they need medicine for their nerves or their moods, like most of the other women they know. They want me only to help them figure out which one. The confusion used to be: “I can’t understand why I keep waking up at four in the morning,” “It’s so hard to get out of bed and I don’t really care about anything,” “I’m angry all the time, and I don’t know why.” But over the years, the conversation has morphed, so that now it usually begins with something like this: “Can you tell me the difference between Wellbutrin and Effexor?” “I can’t figure out if I have ADD or OCD,” “Do you know that ad with the woman riding the horse on the beach?,” “Is that new butterfly sleeping pill better than Ambien?” And the one I hear more than you can imagine from my established patients: “Is there anything new I can try?”

Can you quickly explain the science behind estrogen, serotonin, and how our moods function, as well as how antidepressants affect our emotions?

As women, our interior lives are complex and ever changing. Our neurotransmitters and our hormones—estrogen in particular—are intricately linked. When estrogen levels drop, as in PMS, postpartum, or perimenopause, it’s common for moods to plummet as well. Waxing and waning levels of estrogen help us to be more emotional, allow us to cry more easily and even to break down when we’re overwhelmed. There are estrogen receptors throughout the brain that affect our mood and behavior, and there are complex back-and-forth interactions in the brain between estrogen and serotonin, the main neurotransmitter implicated in anxiety and depression. Although it’s more complicated than I’m making it out to be, it’s helpful to think of serotonin and estrogen as yoked. When one is up, the other is likely to be as well. So it is not your imagination. Where you are in your reproductive cycle, monthly and over your lifetime, is an enormous factor in determining what you are feeling.

Think of serotonin as the “it’s all good” brain chemical. Too high and you don’t care much about anything, too low and everything seems like a problem to be fixed. When serotonin levels are lower, as is seen in PMS, emotional sensitivity is heightened. We’re less insulated and end up more cranky, irritable, and dissatisfied. The most common antidepressants, also used to treat anxiety, are serotonin reuptake inhibitors (SSRIs). These are medicines (such as Prozac, Zoloft, Paxil, Celexa, and Lexapro) that block the brain’s natural recycling of the serotonin back into the nerve cell, so more can get across to the next neuron. If your serotonin levels are constantly, artificially high, you’re at risk of losing the emotional sensitivity that makes you you. You may be less likely to cry in the office or bite your nails to the quick, but you’re also going to have a harder time reacting emotionally and connecting fully with others, especially sexually.

Could you talk about some of the pros to our dynamic moods?



Women have more brain circuitry not only for expressing language and emotion but also for detecting emotional nuance and anticipating what others are feeling. The ability to intuit the emotions and desires of others has helped women for millennia to better predict whether a man may become violent or abandon the children, or whether our nonverbal babies are hungry or in pain.

There is an evolutionary advantage to our cycling hormones and to our dynamic moods. We evolved that way for good reasons; our hormonal oscillations are the basis for a sensitivity that allows us to be responsive to our environment. Our dynamism imparts flexibility and adaptability. Being fixed and rigid does not lend itself to survival. In nature, you adapt or you die. There is tremendous wisdom and peace available to us if we learn how our brains and bodies are supposed to work. Moodiness—being sensitive, caring deeply, and occasionally being acutely dissatisfied—is our natural source of power.

How can someone be sure that they do or do not need medication?

First of all, talk to a therapist or psychiatrist, someone who can take a full hour to hear all your symptoms, your family psychiatric history (genetics are important) and your medication history. Moodiness is not the same thing as a mood disorder, which may require medication. Symptoms of a major depressive episode or post partum depression are at least two weeks of depressed mood, more days than not, as well as changes in sleep, appetite, and energy level.

Women are particularly vulnerable to overprescribing. Doctors are more likely to give women psychiatric medications, especially those between the ages of 35 and 64, who often present with complaints of nervousness, difficulty sleeping, sexual dysfunction, or low energy. The marathon years of perimenopause can bring a lot of women to see their doctors, with complicated symptoms and multiple treatment options (hormone therapy, herbal therapy, or antidepressants can be effective in relieving symptoms).

Keep in mind that these medications were not meant to be taken for years on end. Your situations and stresses will change, your hormones will change, and frequent reevaluation is a must.

As a practicing psychiatrist, how does your belief that women are overprescribed affect your own decisions when it comes to treatments?

Since I’ve been working on Moody Bitches, I’ve been speaking to my patients more about alternative methods to treat their symptoms so we can taper down their doses. For years, I’ve been encouraging all of my patients to do cardio and get more sleep. More recently, I’ve been encouraging an anti-inflammatory diet, fish oils, Vitamins B and D, and probiotics.

But many of my patients really require these medicines to function, and it often takes a therapist and/or a psychiatrist to assist in determining this. Getting off meds is a slow and sometimes painful process. Not everyone will succeed, and honestly, not everyone should try. If you have a definitive bipolar diagnosis, for example, odds are your mood stabilizers are lifesaving and absolutely necessary.