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.

Photo: Getty
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Theresa May is paying the price for mismanaging Boris Johnson

The Foreign Secretary's bruised ego may end up destroying Theresa May. 

And to think that Theresa May scheduled her big speech for this Friday to make sure that Conservative party conference wouldn’t be dominated by the matter of Brexit. Now, thanks to Boris Johnson, it won’t just be her conference, but Labour’s, which is overshadowed by Brexit in general and Tory in-fighting in particular. (One imagines that the Labour leadership will find a way to cope somehow.)

May is paying the price for mismanaging Johnson during her period of political hegemony after she became leader. After he was betrayed by Michael Gove and lacking any particular faction in the parliamentary party, she brought him back from the brink of political death by making him Foreign Secretary, but also used her strength and his weakness to shrink his empire.

The Foreign Office had its responsibility for negotiating Brexit hived off to the newly-created Department for Exiting the European Union (Dexeu) and for navigating post-Brexit trade deals to the Department of International Trade. Johnson was given control of one of the great offices of state, but with no responsibility at all for the greatest foreign policy challenge since the Second World War.

Adding to his discomfort, the new Foreign Secretary was regularly the subject of jokes from the Prime Minister and cabinet colleagues. May likened him to a dog that had to be put down. Philip Hammond quipped about him during his joke-fuelled 2017 Budget. All of which gave Johnson’s allies the impression that Johnson-hunting was a licensed sport as far as Downing Street was concerned. He was then shut out of the election campaign and has continued to be a marginalised figure even as the disappointing election result forced May to involve the wider cabinet in policymaking.

His sense of exclusion from the discussions around May’s Florence speech only added to his sense of isolation. May forgot that if you aren’t going to kill, don’t wound: now, thanks to her lost majority, she can’t afford to put any of the Brexiteers out in the cold, and Johnson is once again where he wants to be: centre-stage. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.