It seemed that this was one big Prozac nation, one big mess of malaise.” Elizabeth Wurtzel’s soundbite on depression has become a common idiom in recent times for describing the ever increasing popularity of antidepressant medication. The idea of a Prozac nation may well be a headline friendly maxim and little more, but the spiralling use of antidepressants is ensuring that it is coming to define a wider debate in the world of psychiatric medicine concerning the quality of treatment given to victims of mental illness in the UK.

 

The implication being not only that antidepressants are arguably over prescribed, ineffective, and possibly dangerous, but that their popularity in health care provision exposes systemic failures in the entire mental health sector of the NHS.

 

Prozac and its family of Selective Serotonin Reuptake Inhibitors (SSRIs) entered the pharmaceutical market in the late 1980s and were promptly heralded as remedies in the clinical treatment of depression, obsessive compulsive disorder, and bulimia nervosa, among a plethora of other mental disorders, and were disassociated from previous tricyclic antidepressant medication that had been known to cause severe side effects.

 

Today more than 40 million depression sufferers take some form of SSRI as part of their treatment, and in the UK alone, prescriptions of antidepressants as a whole staggered over 31 million last year, a figure constituting a six per cent rise on the year before and a new record high.

 

The exact number of people taking pills for depression is unknown but it is thought to be several million, with many taking the medications over long periods on repeat prescriptions. However, cause is increasingly being given to question the practical effectiveness of these drugs. Musings of this sort were nothing new to those in the know in the world of pharmaceutical testing, a selection of whom argued that the popularity of drugs such as Prozac had been conditioned by selective publication of test results.

 

Research published in the New England Journal of Medicine in January this year showed that the results of trials returning a positive outcome on the effectiveness of antidepressant medication were more likely to make it to publication than those returning a negative outcome. The analysis concluded that while in reality only 51 per cent of the trials had returned a positive outcome, any researcher, doctor, or member of the public studying the published research would get the impression that 94 per cent of the trials had returned a positive outcome.

 

Notably it was only after the publication of this research that the global media ran amok with the findings of the now infamous paper submitted to the online journal Public Library of Science Medicine which claimed that analysis of 47 separate clinical trials revealed that modern antidepressants such as Prozac outperformed a placebo only in people with severe depression, with the added qualification that even this group merely responded less to the placebo rather than more to the medication.

 

The involved debate concerns the physical and metaphysical motors of depression, and, indeed, whether depression exists at all. Proponents of SSRIs argue that depression exists at a physical level caused by a lack of serotonin, a neurotransmitter linked to changes in mood. SSRIs, they argue, work simply by increasing the levels of serotonin in the brain. A sedate review argues that depression merely exists at a metaphysical level incapable of being effectively treated with any existing or imagined medication.

 

Depression, it’s said, is an emotional reaction to life’s ills, and can only effectively be tackled with psycho analysis and more modern cognitive behaviour therapies. At a more extreme level, some opponents have gone as far as to argue that SSRIs are essentially cures to a problem that doesn’t exist, and that the true concept of depression has been lost to a new wave of fashionable people that are essentially bummed out. The modern definition of depression, they say, is moulded around the physical effects of the drug.

 

The drug effects mood, appetite, and sleep patterns, so modern descriptions of depression are reflected around... mood, appetite, and sleep patterns. In this guise, Prozac has little to do with any real conceptions of depression, and is instead merely an in vogue accessory of popular culture. Such a body of arguments raises serious questions over the evident dependence of the NHS on SSRIs in the treatment of victims of depression, whatever its definition.

 

Antidepressant medication is evidently becoming a trigger happy response of doctors too quick on the draw of their prescription pads. Research has even shown that doctors themselves know they are prescribing the drugs too often but that they do so because patients wanted medication and because there was little alternative since funding for more involved talking therapies simply wasn’t there.

 

Research carried out by the Liberal Democrats has also shown that victims of depression often face year long waiting times for psychotherapy and counselling treatment. In questioning over 100 NHS trusts throughout the UK, they found that the average longest wait for psychotherapy and counselling treatment was seven months, with six trusts having longest waits of more than two years.

 

The government itself has been taking action to better the performance of the NHS and make it less dependent on the prescription of SSRIs such as Prozac. The Department of Health has issued new targets that should ensure that all patients have access to psychotherapy and counselling treatment within 18 weeks, and £170 million of extra public funding has been injected to pay for 3,600 new therapists.

 

The National Institute for Health and Clinical Excellence has also issued guidelines stating that talking therapies, rather than drugs, should be offered by GPs as a first response to cases of depression. However, it is clear that mental health provisions are low on the list of government priorities when it comes to improving the performance of the NHS.

 

For want of a better phrase, depression is the poor man’s cancer. This condition offers little hope of Britain escaping the label of the Prozac nation, despite the recent evidence of the drug’s poor clinical performance, and even less hope for the millions of sufferers of depression dependent on the NHS to make them better. To quote Wurtzel again, “A human being can survive almost anything, as long as they see the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” In the Prozac nation, the fog just got thicker.