Almost 71m prescriptions for antidepressants were given out in England last year – not including drugs dispensed in hospitals outside the NHS. This is a vast number of pills – more than twice the number of prescriptions given for antibiotics; 20m more than for cholesterol-lowering statins. In a decade, the number of antidepressant prescriptions has doubled; it has risen by 3m in a year. Around 7 million adults (16% of the English adult population) are now taking this medicine, and around 330,000 children.
The new data can’t say whether more people are depressed than previously – only that more are being medicated. The most recent official survey, in 2016, revealed an increase in rates of the most common mental health conditions among women, particularly teenage girls. Recent reports from a commission assembled by the Lancet medical journal, and the World Health Organization, have warned of a growing global mental health crisis, and called on policymakers and professionals worldwide to make this a priority.
While people being ill is bad news, reports of people being treated for illness should, so long as the treatment is appropriate, be welcomed. Some researchers believe mental disorders remain under-treated because they are poorly understood, because doctors and patients share doubts about the remedies, and because of the social stigma that makes people reluctant to report symptoms or seek a diagnosis. But even granting that some people may be taking antidepressants who previously went untreated, there is a debate about whether pills are being overprescribed.
Mental illness remains a complicated and contested area. A study last year that looked at the results of more than 500 trials concluded that antidepressants – most of which are SSRIs, or selective serotonin reuptake inhibitors – are effective treatments. But psychological therapies are also effective, and recommended in the UK for depression along with drugs. While a prescription remains the most common outcome of a GP visit, waiting lists for talking therapy are long and there is evidence that older people are referred less often than other age groups, despite a government programme supposed to boost access to this kind of support. Meanwhile MPs have raised concerns about the difficulties patients have coming off antidepressants, while evidence about long-term use is scarce.
Antidepressants are a vital tool and are among the most commonly prescribed drugs in the western world. But they must not be the only therapy offered to depressed people, who can benefit from other forms of help – including the chance to think about what has made them unwell, if there are personal or environmental factors. The promised boost in so-called “social prescribing” by GPs, of exercise and activities, could be a positive step. As the NHS recognises, brain chemistry is not the be all and end all.
