The prescribing of antidepressants has been increasing sharply in England over the last two decades. In 1998, doctors dispensed them at a rate of one item – a single supply of the drug on a prescription form – for every three people in the country. They now prescribe one item per person. The reason for this dramatic increase is unclear, but it’s not because depression has become more prevalent.
Most antidepressants are prescribed by general practitioners. There are around 7,500 such practices in England. Some prescribe a handful of items a month; others prescribe thousands. But the gaps in the mental health incidence between such practice areas are never sufficiently large to explain such wide variation.
While rates of prescriptions do tend to be lower in areas where people judge their happiness to be either “good” or “very good,” a Tortoise analysis of official data shows that the relationship is weak. Statistically speaking, it’s insignificant: more likely the result of chance than causality.
Another explanation for the general upward trend in prescriptions is the ageing population – and the data do show that areas with concentrations of older people tend to have higher prescription rates. Again, however, this is not the key determinant: on average across England, a local area’s elderly population explains very little – just 12 per cent – of its antidepressant consumption.
A map of antidepressant prescription rates gets us closer to an answer. Rates are highest in some of the old manufacturing and mining areas – Sunderland and Newcastle, Redcar, Gateshead, and Durham – and decaying coastal towns like Blackpool and Hastings.
In short, antidepressants are prescribed most where deprivation – measured according to income, education, health, and housing – is highest. That the issue, on a population level, is financial and domestic more so than illness-related shouldn’t surprise us.
Many people present as genuinely depressed to their GPs. Many more say they’re depressed and refer to work or housing-related pressures they’re experiencing. As one doctor tells Tortoise: if what was occurring in their lives was occurring in his, he too would feel “depressed.” The diagnostic process is simple in such instances: these patients were experiencing circumstances of deprivation that made them unhappy.
On which note: it’s notable that people are now much more likely to tell you that they’re “depressed” than “unhappy.” They’re more likely to think it, too. Around two decades ago, the volume of Google searches for “depressed” and “unhappy” in England were at about the same level. In 2021, there are now four-times more searches for “depressed.”
The change isn’t just colloquial. It has big implications. If a person is diagnosed as depressed, they’re suffering from depression. Depression in its various forms is a real and serious illness. So the person is ill and needs doctors and drugs. This is not just a matter of mood or routine sadness.
To some extent, this reflects an evolving social context: changes in the way we speak about mental health, and the cultural expectation that, somehow, we should be happy all of the time. Another factor is the pressure upon doctors and the inadequacy of mental health services: it is often considerably easier to prescribe antidepressants than to put a patient on a waiting list for therapy. The marketing departments of the pharmaceutical industry nurture the idea that a pill is a more straightforward option than a talking cure (the supply of which is desperately scarce).
Not all unhappy people need antidepressants. Even so – the data suggest – they get them anyway. An antidepressant won’t sort out their bad housing or employment situation. It may make these conditions more bearable. But all these medications have side-effects, especially if taken for long periods of time; and, while psychiatrists argue that they often provide a useful stability before the work of therapy or rehabilitation begins, they do not in themselves address the root problem.
Deprivation requires a different kind of treatment; pills don’t cure poverty. The local areas of high prescription rates are bedevilled by rotting houses, low incomes, poor health, and limited prospects. For many people across England, the current prescription is not the cure.
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