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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Theresa May's big thinker - an interview with George Freeman

The Conservative policy board chair on the meaning of Brexit, state intervention and whether "Mayism" exists.

Theresa May’s three months as Prime Minister have been marked by ruthless changes of both personnel and policy, from grammar schools to fiscal targets. The man tasked with overseeing the latter is George Freeman, a newly bearded 49-year-old who jokingly describes himself as “a designated thinker”.

“It’s a huge privilege,” Freeman told me when we met recently in Westminster. “As [May] has indicated, she’s determined to open up the policymaking process to good ideas from a much wider pool.”

After entering parliament as the MP for Mid Norfolk in 2010, Freeman distinguished himself as one of the most intellectually energetic Tory MPs. He founded the 2020 group of Conservative modernisers and became the first ever life sciences minister in 2014. Before this, he had worked for 15 years as a biotech entrepreneur.

Politics is in his blood. The Liberal prime minister William Gladstone was his great-great-great-uncle and Mabel Philipson, the first female Conservative MP, his great-aunt. Yet Freeman attributes his reformist zeal to the belief that “with privilege comes responsibility”. He boarded at Radley College after his parents, both alcoholics, divorced and has spoken of his “emotionally damaged” childhood.

It is unsurprising that May, confronted by the greatest policy challenge since 1945 – EU withdrawal – has called on his services. The chair of the Prime Minister’s policy board, to give Freeman his official title, was a passionate Remainer but told me “we are now all Brexiteers”. The “Brexit roar”, he explained, was “a mixture of very deeply felt concerns and complaints about globalisation, powerlessness and the growing gap between London and [other] places . . .

“There’s an understanding that if we simply delivered Brexit, and didn’t tackle the rest, we would only have dealt with some of the problem.”

His ambition was “to do for our generation what Disraeli did in the 19th century, in understanding that the extraordinarily challenging pace of franchise extension was also a huge opportunity to harness and fashion a New Model Conservative Party”.

Besides abandoning the surplus target (“to boost growth and investment in infrastructure”), Freeman cited welfare policy as a point of departure. The government would “better differentiate” between changes in the welfare budget and systemic reform – a division that May believes was eroded by George Osborne.

The Prime Minister underlined her commitment to industrial strategy by naming a new department after it. But what does it mean? “I think there is a recognition that we are embracing something unrecognisable from the failed ‘beer and sandwiches’ interventionism of the Sixties and Seventies,” Freeman said. “Twenty-first-century Conservative industrial strategy is about backing our science, innovation and knowledge economy, and other sectors where we have serious global leadership.” He spoke of “stepping in where only the state can”, citing the publicly funded Diamond Light Source synchrotron facility, which he recently visited with the astronaut Tim Peake. The government must be not merely “pro-enterprise”, but “more enterprising”.

May has endured her heaviest dissent over education, and Freeman was notably lukewarm about the idea of new grammar schools. “As well as her position” on the latter, he emphasised, “the Prime Minister set out a much broader vision”. Asked whether he understood MPs’ objections to academic selection, he said “there will be all the usual consultation and discussions through parliament about specific measures”.

The Prime Minister has entered office with greater ideological definition to her thinking than David Cameron, who struggled to reconcile his early vision with austerity. Can we speak of “Mayism”? “I’m not sure the ‘ism’ is helpful or appropriate at this stage. The Prime Minister is very strongly driven by her conservative values, and converting those values into effective policies to tackle the challenges we face. I think we have to wait for the judgement of history to define the ism.”

Freeman is close to “DC” (as he calls Cameron) and praised his premiership. “I was very sorry to see him go. But in the end, given the way the referendum turned out, it was inevitable. I thought he handled that whole last week in the most exemplary way: typical of the man. In time, I think he will come to be recognised as a transformational leader who brought the Conservative Party to terms with modern Britain.”

He rejected the former education secretary Nicky Morgan’s suggestion that May would struggle to “reach into” the marginal seats that the Tories won under Cameron. “Theresa May is appealing widely across whole swaths of the country as a One-Nation leader,” he declared.

With the re-election of Jeremy Corbyn, Freeman said, “the centre ground of British politics, once dominated by Blair and New Labour, has been vacated . . . That is a huge opportunity for a One-Nation Conservative Party to demonstrate our relevance beyond our core vote to those around the country who have clearly felt so marginalised.”

Corbyn’s triumph “illustrates the extraordinary challenge for mainstream political parties in this age of asymmetric, post-Brexit politics . . . We now have to use the opportunity of incumbency in government to tackle the root causes of the insurgency that has taken out the Labour Party.”

Freeman acknowledged the risk that Labour’s divisions would produce an internal Tory opposition.

“It also creates a question for the Conservative Party. Will we turn in on ourselves and generate our own arguments, or unite and reach out into the space that Corbyn has vacated?” 

George Eaton is political editor of the New Statesman.

This article first appeared in the 29 September 2016 issue of the New Statesman, May’s new Tories