Global Health Asia-Pacific July 2020 July 2020 | Page 53
year in the UK, Canada, and Australia, just to name a
few countries with high numbers of drug consumption.
Even more alarming is the rise of deadly
antidepressant use.
In the U.S., there’s been a steady increase in
medication overdose deaths, from 1,749 in 1999 to
5,064 in 2018, according to the National Institute on
Drug Abuse. In some cases, though, antidepressants
weren’t the only cause of death as they were taken in
combination with other addictive substances.
In Australia, the number of people who overdosed
on antidepressants more than doubled between 1999
and 2016, when 276 individuals died, accounting for
15.3 percent of all drug-induced deaths in the country,
according to the Australian Bureau of Statistics.
The reasons that have led to this massive use of
antidepressants are a complex mix of factors. They
sit at the intersection of personal values on mental
health, how to deal with distress, the power of drug
marketing, the influence of doctors, and gaps in
therapeutic services. But some of them seem to carry
undeniable weight.
Firstly, the looseness of diagnostic labels
around depression certainly contributes to soaring
antidepressant prescriptions.
According to the Diagnostic and Statistical Manual
(DSM), a key reference for psychiatric diagnosis
worldwide, the condition technically known as major
depressive disorder (MDD) should be diagnosed when
people have a depressed mood or diminished interest
in almost all activities, along with at least four other
symptoms like appetite or sleep disturbance, fatigue,
feelings of worthlessness, decreased concentration,
and recurrent suicidal thoughts for at least two weeks.
This definition opens up vast diagnostic and
misdiagnosis opportunities, especially in people who
have gone through distressing events, like the loss
of a loved one. It can be argued, for example, that a
bereaved person could display signs of MDD for more
than two weeks, but this doesn’t make them mentally
ill.
�The MDD definition works well at the severe
end, but at the mild end it has led to the creeping
repackaging of everyday normal unhappiness into
mental disorder,” Dr Allen Frances, a psychiatrist and
chairman of the task force that produced the fourth
edition of the DSM, wrote in Saving Normal. “There is
no way to demarcate a clean boundary between the
milder forms of clinical depression and severer forms
of ordinary, normal sadness.”
This diagnostic difficulty extends beyond
depression to the entire realm of mental disease and
boils down to the lack of biological markers for mental
problems. With the lack of specific characteristics
that can be detected through medical examination
like blood test or brain imaging, mental illnesses are
diagnosed by checking a list of symptoms that a group
of experts have agreed on.
“The absence of biological tests is a huge
disadvantage for psychiatry. It means that all of our
diagnoses are now based on subjective judgments
that are inherently fallible and prey to capricious
change,� wrote Dr �rances, stressing that no definition
of mental disorder is particularly helpful in determining
who is sick and who isn’t.
Coupled with the reality of general practitioners
lacking time and alternatives to drugs, such diagnostic
looseness has translated into a vicious circle where
people get unnecessary drugs that trap them for long
periods of time.
“There’s nothing easier in the world than starting an
antidepressant. Primary care doctors are given far too
little time with their patients, and the only way they can
get a patient out of the office satisfied after a sevenminute
visit is to write a prescription,” Dr Frances told
CNN, noting that in the U.S. general practitioners
prescribe around 80 percent of antidepressants. “On
the other hand, stopping the medicine can take years.
It requires for some people a very, very slow taper,
and without that they’ll have symptoms of return of
anxiety, of depression, flu-like physical symptoms, and
often they will misattribute these return of symptoms
to thinking that they’re getting depressed again, when
in fact it’s �ust the result of withdrawal side effects.�
Even when doctors are aware of the risks,
antidepressants may be the only option available.
“No doctor wants their patients to be reliant on
medication – and most patients don’t want this,
either – so where possible we will consider alternative
treatments, such as CBT and talking therapies, but
unfortunately access to these important services in
the community is patchy across the country,” said
Professor Helen Stokes-Lampard, Chair of the UK
Royal College of General Practitioners, in a statement
that tried to explain why antidepressants prescriptions
in England almost doubled in ten years to reach 70.9
million in 2018.
Antidepressants have seen an explosive rise
Firstly, the
looseness of
diagnostic
labels around
depression
certainly
contributes
to soaring
antidepressant
prescriptions
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