Between 2021 and 2022 more than 3.5 million Australians were dispensed an antidepressant, 1 in 7 of us, making this one of the highest rates in the world. Most people have come to believe that depression is due to ‘a chemical imbalance in the brain’ with too little serotonin, the chemical which makes us feel good. However, this has been proved not to be true and in fact antidepressants are emotional and sexual numbing agents which may sedate or energize. People describe difficult side effects including insomnia, restlessness, nausea, weight gain and sexual dysfunction, the very difficulties that may have contributed to the diagnosis. On withdrawal around 50% experience distressing symptoms which may also be confused with the original malaise.
Why are Prescribing Rates so High?
Writing in The Conversation, Jon Jureidini identifies factors that have contributed to this. He points to the aggressive marketing campaigns by pharmaceutical companies in the 1990’s when selective serotonin uptake inhibitors (SSRI’s), Prozac, Zoloft, and Lexapro were developed and promoted as safer and with less side effects than earlier tricyclic antidepressants. With the support of high-status clinicians, the market grew. There is little doubt that they have been a profitable income source.
The Burden on GP’s
GPs write 85% of all prescriptions and while some address more severe depression and anxiety this does not account for all. Jureidini (2024) suggests that antidepressants are frequently offered by doctors or requested by patients for intractable and complex life problems. The GP may be overburdened and unable to give the time or attention to a patient appropriately distressed by a diagnosis of cancer, family conflict and fracture, or death of a spouse. Distress at these times can be high and require a skilled response rather than numbing the pain with drugs. Patients may also present to their doctor convinced that an antidepressant is the answer based on the advice of a friend or media. It is easier to comply than argue.
What Does this Mean?
Life is worrying, disturbing and sometimes deeply sad, especially when there appears to be nothing, we can do to change the situation. Jureidini (2024) argues that overprescribing reflects the lack of acknowledgement of the social determinants of mental health. ‘It’s depressing to be poor (especially when your neighbours seem rich), unemployed or in an awful workplace, inadequately housed or fearful of family violence. It’s wrong to locate the problem in the individual when it belongs to society.’
He goes on to suggest that overprescribing reflects the ‘medicalisation of distress’ with most diagnoses of anxiety and depression being ‘descriptions masquerading as explanations.’ While two people with the same diagnosis may show the same behaviours, for example, crying, sleep disturbance, inability to get out of bed and lack of appetite, one may be responding to the death of a spouse while the other has learned their partner has sexually abused a child. It looks the same, but the reasons and the most appropriate response are vastly different.
In Conclusion
There is no doubt that, irrespective of our understanding of how anti-depressant medication works, some people report positive outcomes. However, there are many who may be suffering unpleasant side effects with little benefit who may be better served by the ‘talking cure.’
Jureidini, J Why are so many Australians taking antidepressants? The Conversation Au
Published: February 9, 2024, 6.17am AEDT