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.