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 boy who lies: what the Daily Prophet can teach us about fake news

The students at Hogwarts are living in an echo chamber of secrets.

They can make objects levitate, conjure up spirit animals and harness the power of invisibility. But perhaps the strangest thing about the witches and wizards of the Harry Potter universe is that despite all their magic, they still rely on old-fashioned print media for their news.

Although the Daily Prophet bills itself as “the wizarding world’s beguiling broadsheet of choice”, the reality is that its readers have no choice at all. Wizards don’t have their own television network – the risk of muggles accidentally tuning in was deemed too high – they don’t generally use the internet, and rival publications are virtually non-existent. (No, Witch Weekly doesn’t count.)

JK Rowling clearly sought to satirise the press in her portrayal of the Prophet, particularly through its poisonous celebrity journalist Rita Skeeter and her tenuous relationship with the truth. And in doing so, the author highlighted a phenomenon that has since become embedded within the muggle political landscape – fake news, and how quickly it can spread.

In the run-up to the recent French presidential election, an Oxford University study found that up to a quarter of related political stories shared on Twitter were fake – or at least passing off “ideologically extreme” opinion as fact.

While they don’t have social media at Hogwarts – probably for the better, despite the countless Instagram opportunities that would come with living in an enchanted castle – made-up stories travel fast by word of mouth (or owl.) The students are so insulated from the outside world, the house system often immersing them in an echo chamber of their peers, they frequently have no way to fact-check rumours and form rational opinions about current events.

When the Ministry of Magic flatly refuses to believe that Voldemort has returned – and uses the Prophet to smear Harry and Dumbledore – most students and their parents have no choice but to believe it. “ALL IS WELL”, the Prophet’s front page proclaims, asking pointedly whether Harry is now “The boy who lies?”

While Harry eventually gets his side of the story published, it’s in The Quibbler – a somewhat niche magazine that’s not exactly light on conspiracy theories – and written by Skeeter. He is telling the truth – but how is anyone to really know, given both the questionable magazine and Skeeter’s track record?

After Voldemort’s followers take over the Ministry, the Prophet stops reporting deaths the Death Eaters are responsible for and starts printing more fake stories – including a claim that muggle-born wizards steal their magical powers from pure-bloods.

In response, Harry and his allies turn to their other meagre sources such as The Quibbler and Potterwatch, an underground pirate radio show that requires a password to listen – useful to some, but not exactly open and accessible journalism.

Rowling is clear that Harry’s celebrity makes it hard for him to fit in at Hogwarts, with fellow students often resenting his special status. Do so many believe the Prophet’s smear campaign because they were unconsciously (or actively) looking forward to his downfall?

We are certainly more likely to believe fake news when it confirms our personal biases, regardless of how intelligently or critically we think we look at the world. Could this explain why, at the start of last week, thousands of social media users gleefully retweeted a Daily Mail front page calling on Theresa May to step down that was blatantly a poorly-edited fake?

The non-stop Hogwarts rumour mill illustrates the damage that a dearth of reliable sources of information can cause to public debate. But at the other end of the scale, the saturation of news on the muggle internet means it can also be hugely challenging to separate fact from fiction.

No one is totally free from bias – even those people or sources whose opinions we share. In this world of alternative facts, it is crucial to remember that all stories are presented in a certain way for a reason – whether that’s to advance a political argument, reaffirm and promote the writer’s own worldview, or stop an inconvenient teenage wizard from interfering with the Ministry of Magic’s plans.

Now read the other articles included in the New Statesman’s Harry Potter Week.

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