published on, 1 October 2014

Wow. A headline on the radio last night caught me by surprise.

‘Over three quarters of a million people in Scotland are on prescribed anti-depressants.’

It made me think. That’s a lot of people, right?

And I am one of them.

I started listening as the news report went on. There was a strong implication that the numbers taking such medication were on the rise, and there were too many people taking them. Somehow things were getting out of hand.

The report ended with a quote from the Scottish government, saying that they were doing everything they could to remove the stigma of mental illness, blah blah.

But the point was clear. Something needed to be done, there are too many people taking anti-depressants. Somehow the medical profession had failed, and even more so the people on these medications had also failed.

So what does it mean to remove the stigma of mental illness?

For a start, perhaps we need to remove the stigma of the treatment of mental illness.

Anti-depressants are not perfect. There are several different kinds, some work better than others – and this can vary according to the person being treated.

I have been taking mirtazapine for most of this year. I take it every night, which means I usually get a good sleep – something that was near impossible before I started taking them. I have tried other anti-depressants, and would like to live my life without them. Hopefully I will be able to in a year or so.

But I know they are a medicine that helps my illness at the moment.

My taking them does not mean that I am crazy, nor does it mean I’m hopelessly drugged up and out of reality. Or at least I don’t think so.

The real issue of the headline is that there are a lot of people in Scotland (and of course in most countries) who have some sort of mental illness.

From wider studies, it is fair to assume that the number is somewhere around a quarter of the population (according to the Mental Health Foundation).

One in four.

Rather than counting (and then exclaiming about) the number of prescriptions given, the question should be about whether people with mental ill health are getting enough of the treatment they need?

Are the anti-depressants working? If yes, then they should be used more. If no, then what else can help?

In the UK, we live in a society with pitiably ineffective health care facilities for those who are mentally ill. This is not surprising, since in large part public health as a whole is straining under a million pressures.

And within this, mental health care is very often one of the Cinderella areas. It is not sexy, it is rarely seen as a priority, and in large part most treatments for mental illness seem to come down to chemical interventions. When these work they are good, but there should be much more to mental health care.

So on that level, the rise in prescriptions for anti-depressants is a ‘depressing’ piece of news in itself. It would be great to hear that alternatives to drugs were being rolled out successfully to help the one in four who are made ill by mental health problems.

Or to put that another way, it is a shame that we have to rely on drugs alone to help those who are mentally unwell.

But given that such medicine is the primary form of treatment, the rise of anti-depressants can only be a good thing.

Otherwise it would like be saying that the treatment of infections shows an alarming rise in the number of antibiotics being given our, or the treatment of strokes shows an alarming rise in the number of people who are now given warfarin.

In both cases there are other things that can be done to help, as an avoidance of the medicine. Infections are also treated by good hygiene, which requires education and support for the implementation of effective procedures to ensure such hygiene (particularly in places such as hospitals). The avoidance of strokes also requires issues such as diet and exercise, no doubt.

A successful health service needs to be able to manage all these issues, to maximise people’s life chances and the quality of their lives.

And this is no less the case with mental illness.

This requires treatment of the symptoms of depression – including medicines where helpful for those who are suffering. It also requires acute treatments for those who are suffering acutely.

For one in four people, some treatment is a necessity.

And so we also need to find some way of avoiding the hyperbole and sensationalism around the subject. We should give a cautious welcome to news that we are managing to treat more people who are suffering from this illness.

And be aware of when we perpetrate the stigma of mental illness and its treatment.

(Photo credit: “Pristiq pills” by Tom Varco, Own work. Licensed under Creative Commons Attribution 3.0 via Wikimedia Commons)

Are there too many anti-depressants? Or is the problem that there is not enough mental health care?

by Malory Nye time to read: 3 min