“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
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I infrequently get depressed — at least, not severely. One of the only times I can remember experiencing significant depression was during a very difficult medical internship year more than 50 years ago. I wrote about it in my memoir Damn the Naysayers.
I was surprised to read in a recent survey of more than 26,000 adults that 37 percent of Americans take at least one medication that lists depression or suicidal symptoms as a potential side effect. People using such drugs had higher rates of depression than those who didn’t take them. The risk of depression increased with each additional drug taken at the same time: 7 percent for those taking one drug; 9 percent for two drugs; 15% for three or more; versus only 4.7 percent for those not taking any drug.
The overall use of any prescription medication that had depression as a potential adverse effect increased from 35 percent to 38.4 percent between 2005 and 2014. The percentage of adults taking three or more drugs with a depression side effect increased from 6.9 percent to 9.5 percent, and the use of medications with suicidal symptoms as potential side effects increased from 17.3 percent to 23.5 percent. This certainly cannot be helping the well-being of people in our society, already on edge dealing with a variety of issues.
The list of drugs with depression or suicidal thoughts as a side effect include 200 prescription drugs, some well-known to have those side effects, like beta-blockers (e.g., Toprol), but some that may be surprises: common medications like proton pump inhibitors used to treat acid reflux, birth control pills and emergency contraceptives, anticonvulsants like gabapentin, corticosteroids like prednisone, and prescription-strength ibuprofen. Some drugs with depressive side effects are sold over-the-counter.
It’s important to stress that the study, while important, doesn’t establish causality but only an association between these medications and depression. It’s possible people already had a medical history of depression prior to taking the drugs, or the medical conditions they were being treated for might have contributed to their depression. However, the findings persisted when the researchers excluded anyone using psychotropic medications, considered an indicator of underlying depression unrelated to medication use. In addition, the dose-response pattern, i.e., more medications linked to more depression, lends additional credence to the observation.
It is quite clear that polypharmacy can be dangerous and can lead to depressive or suicidal symptoms. Know your drugs! Read the labels! Be sure to review your entire medication list, even dietary supplements, at each encounter with your health care provider, especially if you are cared for by multiple physicians. Take responsibility for your own health. Do not leave it entirely in the hands of someone else. No one will be more concerned about your well-being than you.
If you are having thoughts of suicide, please reach out and talk to someone.
- In the U.S., call the National Suicide Prevention Lifeline, available 24/7 at 1-800-273-TALK (8255)
- The Trevor Project— 866-488-7386 — is a hotline for LGBT youth
- The International Association for Suicide Prevention and Befrienders Worldwidealso provides contact information for crisis centers around the world
The First World War, which the U.S. entered 100 years ago today, is so far in our past that it can feel like ancient history. How can we understand the U.S. of 1917 when so much has changed since then?
One way is to compare what it means to be an “average American” then and now, though we’re fairly certain that Saturday Evening Post readers are, on the whole, above average.
If you were an average American on this day in 1917, you were one of 103 million citizens. (Today’s population is over 320 million.) Being a typical 1917 American, you would be among the 86 percent of the population that was Caucasian, and you would live on a farm or in a town with a population of 2,500 or less. Because of your rural locale, you wouldn’t have heard about that new American music called “jazz” that was brewing in the big cities; it had only been recorded for the first time in March.
Suppose you were the typical woman of 1917. You’d be between the ages of 15 and 19, but you wouldn’t get married until you were 21. You had a life expectancy of 49 years (today it’s 78.8 years). You couldn’t vote, you couldn’t obtain birth control, and you had no education beyond the eighth grade. You were living in your parents’ house. You washed your hair just once a month, and you would probably deliver all three of your babies at home.
But the typical American in 1917 was a man; the majority of Americans were male until the 1950s. As an average American, adult male, you were between 20 and 24 years old with a life expectancy of 47 years.
You worked 55 hours a week for 22 cents an hour, but your income wouldn’t go as far in 1917 as it does today. For example, you would spend 33 percent of your earnings on food (compared to 16 percent today). Every year, you would consume 11.5 pounds of lard, 14 pounds of chicken (it’s over 90 pounds today), and 88 pounds of sugar (at 4 cents a pound). Also, your clothing expenses took up 13 percent of your annual income, compared to just 3 percent today. You’d need to save up almost an entire year’s income to buy the average new car, which cost around $450 (today it’s around $34,000).
However, if you were in the fortunate minority that owned one of the 4.7 million cars on America’s roads in 1917, you would pay as much as 20 cents for a gallon of gas (the equivalent of $3.81 per gallon today). And if you lived in any city, the law would prevent you from traveling faster than 10 miles per hour.
The average new home today costs $390,000. If you had bought an average new home in 1917, it would cost $5,000 (the equivalent of $95,000 in today’s dollars), and you’d share it with four other people instead of the 2.3 others you’d share it with today.
As an average American, you wouldn’t be among the fortunate 14 percent of the population whose homes had bathtubs with running water, or the 18 percent of households with at least one live-in servant. Also, you’d have no phone in your home; that was a privilege enjoyed by only 8 percent of Americans. Instead, your long-distance communication would be done by mail, though Americans sent six times more telegrams than letters.
As a typical male in 1917, you wouldn’t have graduated from high school — only 10 percent did so — but at least you could read and write (25 percent of Americans couldn’t). You would be considered ready for military service. Before the war was over, if you were between 18 and 31, you had a 25 percent chance of serving in uniform, as either a draftee or a volunteer.
If you did end up as an average soldier in the armed forces, you would be 25 years old, 5 feet, 7½ inches tall, and a compact 144 pounds, with a 31-inch waist and 14-inch neck. Most likely, you would be among the 4 million American men who served in the American Expeditionary Forces. If so, you had a 50/50 chance of serving overseas, a 5 percent chance of being wounded in battle, and a 1.3 percent chance of being killed in the fighting. But, as a typical G.I. (a term that wouldn’t be in use until the next world war), you would not be among the 43,000 servicemen who died of influenza during and after the war.
However, when you got home in 1918 after surviving the flu epidemic and the war, you would no longer be the typical American you’d been in 1917.
Will 2012 go down in history as the year money took over politics? Both parties will have spent more than a billion dollars electing the next president. More and more of that money comes from a handful of the wealthiest Americans and the corporations they run. On the Democratic side, Jeffrey Katzenberg of DreamWorks, telecommunications pioneer Irwin Mark Jacobs, and hedge fund manager James Simons have donated millions to re-elect the president, but the amount of money the Democrats have received from deep-pocketed supporters pales in comparison to what Republicans have received. A single billionaire, business magnate Sheldon Adelson, had by August spent more than $41 million and promised to spend up to $100 million defeating President Obama and other Democrats. All told, the top .07 percent of donors give more money than the bottom 86 percent. And it pays off. Candidates spend ever more time courting the super rich and then, once in office, try to keep them happy. This summer, for example, Mitt Romney held two fundraisers at which he raised almost $10 million from the oil and gas industry and then announced that as president he would end more than 100 years of federal restraint of oil and gas drilling on public lands. Things like that happen on both sides. How did we get into such a situation? What is to be done about it? Is it threatening our democracy? And doesn’t it go against everything the founding fathers stood for?
Those are big questions. The last one is the easiest to answer. Control of government by the richest wouldn’t have bothered the founders at all. It was just what they believed in. John Jay, the first Chief Justice, put it most directly: “The people who own the country ought to govern it.”
Many of the founders, including George Washington and Thomas Jefferson, were themselves among the wealthiest people in the country. They felt their prosperity made them obliged to serve their nation at the highest level. Yes, they declared independence and fought a Revolution to escape the tyranny of English monarchy and might, but they expected to replace aristocracy of birth with aristocracy of accomplishment, rule by elites who had created their wealth and influence, not inherited it. That was why they wrote a Constitution that stated the president was to be elected not by the people but by an elite Electoral College, and the Senate was to be chosen not by the people but by state legislatures. And that was why in most states only men who had money and property were allowed to vote at all.
It didn’t take long for the 99 percent of the day to rebel against that status quo. The notion of true democracy, rule by ordinary people, grew popular in the early 19th century. It was spearheaded by President Andrew Jackson, who hated bankers and banks, especially the national bank that had been founded by Alexander Hamilton. He destroyed the bank, partly to counter the power of the richest Americans. At the same time, a new generation of wealthiest Americans emerged, and they were a breed that had never existed in Europe—industrious, self-made men of humble origins, such as John Jacob Astor, a German immigrant who began working in a menial job for a fur merchant but came to dominate the trade in furs from the West, and Cornelius Vanderbilt, who rose from ferryboat captain to steamboat owner and then railroad baron. In 19th century America, the wealthiest really did have something in common with the common man.
Or at least that was true in the American North. The elite of the South were a breed apart. They grew fantastically rich and powerful from growing rice and cotton with all the hardest labor done by slaves. Seven of the first 12 presidents were from Virginia, the most prosperous part of the South. When the Civil War came, it was a fight not only over slavery but between the power of new Northern industry and urban wealth and the spoils of the Southern slave economy as well.
As extreme as the power of the wealthiest is today, it pales before that of the rich in the pre-Civil War South, for they could own human beings who had no rights whatsoever. Slave owners had such full support of the law that the Constitution originally counted each slave as three-fifths of a man for voting purposes, not so that slaves themselves could vote, but to add to the headcounts on which Congressional districts were based, giving their owners even more political and electoral power than anyone who didn’t keep slaves. Slavery was by far the highest point of the tyranny of the wealthiest in the United States.
But the kind of abuse of power that’s more familiar to us today took off after the Civil War, when four years of bloodshed costing more than a million lives left the South crippled and the North as a new industrial world power. That power corrupted, as it always does. The Gilded Age—which lasted from the end of the Civil War to 1900—was a festival of power grabs among the wealthiest. For instance, to build the Transcontinental Railroad, the owners of the Union Pacific Railroad set up a construction firm called Credit Mobilier to wildly overcharge for the work it did, just so they could bleed their own company and bondholders. Then, to make sure Congress didn’t complain, they gave assorted Congressmen both cash bribes and stock that paid huge dividends. The scam got exposed in 1872. It was estimated to have stolen $42 million in government and bondholder money, and it led to the disgrace of public figures as high up as the vice president, Schuyler Colfax.
By the 1880s the Senate was dominated by millionaires. And by 1892, wealth-fed scandal had become so commonplace that opposition to it gave rise to a new political party, the Populists, whose platform announced, “We meet in the midst of a nation brought to the verge of moral, political, and material ruin. Corruption dominates the ballot-box, the Legislatures, the Congress, and touches even the ermine of the bench. … The fruits of the toil of millions are boldly stolen to build up colossal fortunes for a few. … From the same prolific womb of governmental injustice we breed the two great classes—tramps and millionaires.”
When Theodore Roosevelt became president in 1901, he ushered in the Progressive Era, one of two major periods in U.S. history when the political tide turned strongly away from the wealthiest—the other was during the presidency of his distant cousin Franklin Roosevelt. Roosevelt railed against what he called “malefactors of great wealth” and the “criminal rich,” and he pushed through reforms like strengthened railroad regulations and the creation of the Department of Labor. A decade later, President Woodrow Wilson cemented Roosevelt’s accomplishments by establishing the federal income tax and the direct election of senators.
We know now that Government by organized money is just as dangerous as Government by organized mob.
Though none of that prevented the wild financial bubble fed by coziness between the wealthy and the government in the 1920s. So in the wake of the Great Crash that followed, Franklin Roosevelt took office in 1933 as a rich New Yorker determined to look out for the common man. He wrote to a friend, “The real truth of the matter is, as you and I know, that a financial element in the larger centers has owned the Government since the days of Andrew Jackson. … The country is going through a repetition of Jackson’s fight with the Bank of the United States—only on a far bigger and broader basis.” He raised taxes on the rich and used much of the money that came in to put the unemployed poor back to work. In 1936 he wrote: “We know now that Government by organized money is just as dangerous as Government by organized mob. … I should like to have it said of my first Administration that in it, the forces of selfishness and lust for power met their match. I should like to have it said of my second Administration that in it these forces met their master.”