Our use of anti-depressants continues to rise. Figures from the Health and Social Care Information Centre revealed that in just three years – between 2010 and 2013 – prescribing in England rose by 25% and culminated in a record high of 53m prescriptions. To put this into perspective, there are only 52.6m people in England. This bizarre level of the medicalisation of human distress could be considered a national scandal.
If there really has been that kind of increase in the number of people needing treatment for depression then we should surely be trying to address the causes of that – starting with poverty, the strongest predictor of virtually every mental health problem. For a country that is listed as the sixth biggest economy in the world, we have one of the highest levels of inequality. Loneliness, unemployment, and having to work two or three jobs on zero-hour contracts to make ends meet, are also major sources of stress for many.
Although we should look at why people might be depressed, increases of this magnitude are also fuelled by drug companies and psychiatrists with a rather simplistic, biological view of mental health problems, who try to persuade us that sadness and grief are signs of an “illness” called “depression”.
Feeling down, even feeling very down for a very long time, is not an illness. Depression is almost always caused by depressing things happening. If someone close to us dies, of course our brains react to that, but, contrary to the “chemical imbalance” model of depression espoused by drug companies, that doesn’t mean our sadness is caused by those changes in the brain. It is caused by the loss.
Drug company advertising is particularly targeted at women, who are twice as likely to be diagnosed with depression as men and twice as likely to be prescribed antidepressants as men. Surely that illustrates we are dealing with a social phenomenon not a medical one?
A survey of websites offering information about depression that we carried out in 2009 found that 42% were drug company funded. These industry sponsored websites were significantly more likely than other websites to promulgate an illness model of depression, and to recommend antidepressants than other websites.
Antidepressants come with side effects. While some of the biological effects have been seen in clinical observations, a survey of nearly 2,000 people taking antidepressants that we published earlier this year found the following rates of adverse emotional and interpersonal effects: sexual difficulties (62%); emotional numbing (60%); drowsiness (58%); reduced positive feelings (42%); and, of particular concern, suicidal feelings (39%).
Now that researchers have access to all the studies that used to be buried by the pharmaceutical industry, we now know that these drugs are no more effective than placebo for all but a small minority of the most severely depressed people, meaning that the vast majority are being exposed to these adverse effects without receiving any benefit beyond the placebo effects of hope and expectation.
The situation is likely to become even worse if doctors deploy the new diagnostic criteria for depression in the latest edition of the Diagnostic and Statistical Manual, or DSM-5, which reduced the time of “normal” grieving after the loss of a loved one from two months to two weeks, after which time one supposedly has a disorder in need of treatment.
But we can’t just blame the drug companies, or doctors (who have so little time), for this alarming situation. Millions of us are choosing to take them. The alternatives include: accepting that from time to time life is sad, sometimes deeply sad; seeking alternative support from friends and family or non-medical professionals; and finding little ways to work together to make the world around us, and our society as a whole, a little less depressing.