Apathy in the U.K

The U.K is feeling down. According to research by the Health and Social Care Information Centre, there’s been a 7% increase in the number of people prescribed antidepressants by 2013. That means this number has now increased. The number ‘7%’ can’t accurately portray what this means for those millions of people beginning prescription. Most will be starting a life long commitment, a commitment that could alter their brain chemistry, long term mood and levels of anxiety – but often not in a positive way. We now rely on chemical cures for depression. We may not be more depressed than before (though compulsions like ‘social media anxiety’ don’t allude to many positives) but we are medicating it far more than ever before. In the way of the American healthcare system, prescription has become procedure.

 

Medication is necessary in certain cases, and many people are relieved when they find the combination that suits them and helps them control a condition that affects every aspect of life. This article isn’t referring to those with extreme conditions, where a life without a well-placed seroquel, or other anti-psychotics, here and there is unimaginable and unlivable. There are over prescription problems that should breed concern in that area too – but let’s start with the people brought in on the first rung of the ladder.

 

This article is for the huge numbers of those with minor/short-term depression or anxiety who have been told that a pill is the answer. Large amounts of young and vulnerable people are being medicated for a condition they may not have, or one that may be better treated with alternative methods. These are the majority of antidepressant users - those with a minor depression or anxiety condition, usually reactive rather than endogenous - who begin with ‘short term’ treatment. The typical anti-depressant is a SSRI or SNRI; these drugs halt the reuptake of specific neurotransmitters related to mood, specifically serotonin and noradrenalin. This is a biological treatment for what is often a situational or societal problem - a side effect laden treatment for what is often a ‘reactive’ depression. Is it normal to react to sad news by being sad...? to be sad when someone dies? or does it call for medication?

 

The proliferation of psychoactive treatments, over therapy, for children, adolescents and young adults seems strange when you consider that studies report that ‘significantly higher’[1] suicide rates for adolescents on antidepressants. One study found an increased suicide risk of 58% when antidepressants were compared with a placebo. In a group with average risk this would equate to an increase from 25 in 1,000 to 45 in 1,000[2]. Adult users also record increased desire for suicide in early treatment. That explains those scary ‘may increase thoughts of suicide’ notes on the side of the box that have incited irony laced laughs from generations of depressives starting treatment.

 

In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%)[3]. If NHS practice were in line with this biological data, it would have to reverse its current policy. At the moment, drug therapy is considered cheaper, even if it is more dangerous. The ease with which people are prescribed happy pills is laughable, with many people suffering from short-term depression, or just feeling low, being prescribed treatment after a short conversation with their GP. Even if you don’t feel like you are a depressive, a promising pill is a tempting offer to anyone feeling in a dark place, and saying no to a medical professional is against most peoples conditioning.

 

Depression is a mental disease, and so being told yours is bad enough to warrant treatment can be enough to push a person further into its depths. It’s stigmatized, so they will also feel more alone. The powerlessness felt would lead many people, who would otherwise have overcome their depression in the usual way, turning to SSRI’s. Unfortunately, this comfort blanket not only increases suicide risk, it also effects ambition, sex drive, social function and can, for many, begin a cycle of reliance on legal and illegal drugs.

 

An infamous side effect of SSRIs is “amotivational syndrome”. The patient shows apathy, disinhibited behavior, demotivation and a personality change. Its symptoms are similar to those that develop when the frontal lobes of the brain are damaged[4]. Essentially, we’ve created a chemical version of our archaic technique of mashing the brains’ frontal lobes in a lobotomy, a la One Flew Over The Cuckoo’s Nest. This effect is particularly prevalent on those medicated from a young age, and many researchers have linked the use of antidepressants during pregnancy, or in young children, to emotional disorders later in life[5].

 

Researchers at Thomas Jefferson University found that high-dose, short-term exposure to SSRIs in rats was sufficient to produce distortion in the serotonin nerve fibers[6]. So, antidepressants may also arrest neuron development. Would we rather harm our brains irreparably and function adequately, or allow our emotions free reign at the possible detriment of our daily activities? Medication becomes a matter of economics; a person on antidepressants is less likely to take a long leave of absence due to personal tragedy as their chemical apathy allows them to function adequately despite emotional strain. Like a lobotomy, antidepressants can make the patient a perfect citizen: obedient, predictable and controlled. Is this state preferable to the natural, emotional, human condition?

 

How early can you tell if someone has a predisposition to depression? 18? 13? 8…? Fluoxetine, the first on the antidepressant tree to be prescribed to a new patient, is licensed for use in children 8 years and over in the U.K. This means an 8 year old could continue to be medicated indefinitely, with a drug proven to damage their brain and cause dependence, until they choose to stop.  This is despite the evidence of studies showing ‘no statistically significant’ differences between young people with depression being given placebo’s or antidepressants. The very act of medicating a child gives the placebo effect – it validates a belief that they have something that must be medicated.

 

Depression and addiction have been related to human connection in more recent studies. Rats who lived alone had a choice of a heroin bottle, and a water one. They all kept at it till death. Rats who lived community, presented with the same options, lived normal, long, lives. When we have human connection, we don’t need drugs to deal with a short term depression, we have people. Having been on anti-depressants I can tell you that I, for one, felt like I was in a bubble that kept people, and their emotions, at arms length. I was more callous, practical, and less like me. Switching pills for connection – in my case, creating projects with creative people, and writing a lot – could stop a young persons depression from becoming a life long struggle finding the ‘right’ drugs.

 

I recently started the blog Just Gushing for people with all perspectives to share their stories and creations, as a way of connecting and trying to brush off the stigma of mental illness.

 

[1] http://www.sussexpartnership.nhs.uk/component/jdownloads/finish/2050/7883?Itemid=0

[2] Hetrick SE, McKenzie JE, Cox GR, et al; Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2012 Nov 14;11:CD004851. doi: 10.1002/14651858.CD004851.pub3.

[3] Cox GR, Callahan P, Churchill R, et al; Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev. 2012 Nov 14;11:CD008324. doi: 10.1002/14651858.CD008324.pub2.

[4] Marangell et al. 2001, p.1059

[5] Ansorge et al. 2004

[6] Kalia 2000