Are rich countries taking too many antidepressants?

One in 10 people in Iceland are on antidepressants, and prescription rates across the OECD have dramatically increased.

According to a report released today by the OECD, the use of antidepressants in wealthy countries has risen dramatically in the past decade. Across the high-income countries surveyed, the average proportion of people taking antidepressants increased from 3.1 per cent to 5.6 per cent between 2000 and 2011, but use of antidepressant drugs varies by country. In Iceland, one in ten adults is on antidepressants, but in Korea it’s more like 1 in 100. 30 per cent of women over 65 are on antidepressants in Iceland, compared to 15 per cent in Norway.

As the Guardian has reported, these findings have sparked fears that sadness is being over-medicalised, and that over-stretched doctors are forced, because of a shortage of alternative treatments for mild depression, including talking therapies, to over-prescribe.

There may be some truth to this: consider, for instance, that a quarter of people in the UK who are referred by their GP for further psychiatric help – 116,000 in total – have to wait for more than 28 days. For someone in severe distress, this can be too long to wait. You could understand that doctors might be inclined, in border-line cases, to prescribe antidepressants rather than risk leaving an individual showing signs of mild to moderate depression without any support.

The problem, however, is that it’s dangerous to generalise. One notable feature of the OECD report is how different each country’s mental health services and outcomes are. In Switzerland there are 45 psychiatric doctors per 100,000 patients, versus fewer than 10 per 100,000 in Korea, Turkey and Poland. In some countries GPs work much more closely with mental health services than others. Suicide rates across the whole of the OECD have decreased 20 per cent since 1990, but in Japan and Korea they have increased. Suicide rates in Korea (which has the highest suicide rate of the countries surveyed) are ten times higher than in Greece, which has the lowest rate. The excess mortality rate from schizophrenia is twice as high in Sweden as in Slovenia, and equally, a patient with bipolar disorder is three times more likely to die in Sweden as in Denmark.

There are lots of possible explanations for the increased use of anti-depressants across the OECD. Doctors may be over-prescribing, but it could also be that people are using antidepressants for longer periods of time, or that as the stigma lessens around mental illness, more people are seeking help. The chances are the reasons for increased antidepressant use vary by country.

Panic about the over-medicalisation of "sadness", an ordinary human condition, sometimes risk overshadowing the fact every day, antidepressants save countless of lives, and relieve many more people from acute suffering. I am much more worried about the many millions who lack access to any kind of psychological help (many of whom are not in rich countries) than the unknown number of people taking drugs they don’t strictly need.

A bottle of anti-depressant pills. Photo: Getty.

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

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The strange death of boozy Britain: why are young people drinking less?

Ditching alcohol for work.

Whenever horrific tales of the drunken escapades of the youth are reported, one photo reliably gets wheeled out: "bench girl", a young woman lying passed out on a public bench above bottles of booze in Bristol. The image is in urgent need of updating: it is now a decade old. Britain has spent that time moving away from booze.

Individual alcohol consumption in Britain has declined sharply. In 2013, the average person over 15 consumed 9.4 litres of alcohol, 19 per cent less than 2004. As with drugs, the decline in use among the young is particularly notable: the proportion of young adults who are teetotal increased by 40 per cent between 2005 and 2013. But decreased drinking is not only apparent among the young fogeys: 80 per cent of adults are making some effort to drink less, according to a new study by consumer trends agency Future Foundation. No wonder that half of all nightclubs have closed in the last decade. Pubs are also closing down: there are 13 per cent fewer pubs in the UK than in 2002. 

People are too busy vying to get ahead at work to indulge in drinking. A combination of the recession, globalisation and technology has combined to make the work of work more competitive than ever: bad news for alcohol companies. “The cost-benefit analysis for people of going out and getting hammered starts to go out of favour,” says Will Seymour of Future Foundation.

Vincent Dignan is the founder of Magnific, a company that helps tech start-ups. He identifies ditching regular boozing as a turning point in his career. “I noticed a trend of other entrepreneurs drinking three, four or five times a week at different events, while their companies went nowhere,” he says. “I realised I couldn't be just another British guy getting pissed and being mildly hungover while trying to scale a website to a million visitors a month. I feel I have a very slight edge on everyone else. While they're sleeping in, I'm working.” Dignan now only drinks occasionally; he went three months without having a drop of alcohol earlier in the year.

But the decline in booze consumption isn’t only about people becoming more work-driven. There have never been more alternate ways to be entertained than resorting to the bottle. The rise of digital TV, BBC iPlayer and Netflix means most people means that most people have almost limitless choice about what to watch.

Some social lives have also partly migrated online. In many ways this is an unfortunate development, but one upshot has been to reduce alcohol intake. “You don’t need to drink to hang out online,” says Dr James Nicholls, the author of The Politics of Alcohol who now works for Alcohol Concern. 

The sheer cost of boozing also puts people off. Although minimum pricing on booze has not been introduced, a series of taxes have made alcohol more expensive, while a ban on below-cost selling was introduced last year. Across the 28 countries of the EU, only Ireland has higher alcohol and tobacco prices than the UK today; in 1998 prices in the UK were only the fourth most expensive in the EU.

Immigration has also contributed to weaning Britain off booze. The decrease in alcohol consumption “is linked partly to demographic trends: the fall is largest in areas with greater ethnic diversity,” Nicholls says. A third of adults in London, where 37 per cent of the population is foreign born, do not drink alcohol at all, easily the highest of any region in Britain.

The alcohol industry is nothing if not resilient. “By lobbying for lower duty rates, ramping up their marketing and developing new products the big producers are doing their best to make sure the last ten years turn out to be a blip rather than a long term change in culture,” Nicholls says.

But whatever alcohol companies do to fight back against the declining popularity of booze, deep changes in British culture have made booze less attractive. Forget the horrific tales of drunken escapades from Magaluf to the Bullingdon Club. The real story is of the strange death of boozy Britain. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.