Saturday, September 16, 2017

Depression in Great Britain and America

Dr. Max Pemberton, resident psychiatrist at The Daily Mail, raises an interesting question. He does not seem to have the answer, but then again, neither do I.

The question is: if we can now treat depression effectively with anti-depressant medication why does Great Britain, which is awash in the stuff, have such a high rate of depression?

Dr. Max explains:

What is wrong with this country? I mean that quite seriously. Something clearly is not right because, according to new statistics, people in the UK are among the most depressed in the Western world.

The data from the Organisation for Economic Co-operation and Development (OECD) showed that our rates of depression are more than double those of countries such as Poland, Greece, Italy and the Slovak Republic. And that is despite this country having a relatively high standard of living.

Certainly, Great Britain has a higher standard of living than do these other countries. Greece, after all, is the basket case of Europe.

Still, British people, awash in free anti-depressants, count among the most depressed people in Europe:

Consider this: we have some of the highest rates of antidepressant prescribing in the world — and this is rising. The NHS issued 64.7 million prescriptions for antidepressants last year, double the amount from a decade ago. Yet research also shows people are getting more depressed, not less. So what is going on?

The problem, I think, is that the way we understand depression has been dominated in recent years by the idea that it’s just a chemical mishap in the brain; a random imbalance of chemicals.

This has been fuelled by the pharmaceutical industry, which with the development of SSRIs (a group of antidepressants, including Prozac, which are now the most commonly prescribed) has propagated the idea that depression can be treated with pills.

As it happens, America is leading the world in anti-depressant use, followed by Iceland, Australia, Canada and Sweden. Apparently, white privilege is not all it’s knocked up to be. Being guilty about being white and being successful... those qualities, sold relentlessly by our culture ... might well contributing to the problem.

One should also note that American physicians often prescribe opioids for psychiatric conditions like depression and anxiety.

Are Americans, like the British, getting more depressed? Are all those anti-depressants improving the national mood? I suspect that they are not. If psychiatric patients graduate to opioids, the SSRIs are probably not helping. Besides, improved mood comes from belonging to social groups, acting as an ethical individual and having a purpose in life. None of these can be provided by a pill.

Why are there so many prescriptions for antidepressants? For one, it is easier for a physician to prescribe Prozac than to take the time and make the effort to engage with the patient. It is far more cost effective to write a prescription than to conduct cognitive therapy. Somehow or other the famed British National Health Service seems to privilege writing prescriptions… perhaps because they are short on practitioners.

In America the insurance industry bears a considerable part of the blame. Many American psychiatrists stopped doing most kinds of talk therapy because prescription writing was far more lucrative. A psychiatrist receiving three patients in an hour and writing prescriptions will make more money than he would doing an hour of talk therapy. Better yet, the payment for the twenty-minute session is often greater than that for one hour of talk therapy.

As for the numbers, one in six Americans is taking an anti-depressant. Yet we also know that physicians, especially primary care physicians, tend to hand them out for just about anything.

Anyway, Dr. Max declares that our obsession with chemical imbalances has caused us to overlook the social and cultural factors in depression.

He does accept that some depressions come out of nowhere. They seem to have no connection to the patient’s life experience. One might say that he ought to look harder, but depression is not a singular condition. At times there are biochemical causes—as in unipolar depression—but more often there are not.

He offers the gruesome case of a woman had very good reason to be severely depressed:

I remember being asked to see a middle-aged woman who’d come into A&E because she was so depressed she’d stopped eating and drinking.

She was a shell of a human being, totally exhausted and devastated by her depression. She’d previously been admitted for it and little seemed to make it better. She was so depressed she could hardly be bothered to look up.

It transpired it was the anniversary of the deaths of her husband and two children, caused when she had momentarily fallen asleep at the wheel of the family car.

Is what she was experiencing a problem with her brain chemistry? As I listened to her story, her voice thin and distant, her eyes dead and hollow, I asked myself what other possible response there could be to what had happened.

Of course, this is extreme. The woman manifestly feels enormous guilt for a mistake that destroyed the lives of those she loved the most. Surely, we are not in the realm of brain chemistry. Even if the guilt and depression has influenced her brain, taking a pill is not going to make it all right.

Were you to ask me—I know you haven’t—I would say that religion would probably provide more comfort than a psychiatrist’s office. For people who feel socially dislocated, religion provides community. It binds people together. In effect, that is what the Latin root— religio-- means. Could it be that destroying everyone’s religious faith has left people alone and bereft when facing tragedies?

Dr. Max adds this:

I’ve thought the same when I’ve worked with patients with depression who’ve survived genocide and seen terrible atrocities, or at the less extreme end of the scale, the single mum who’s living in a high-rise with screaming kids, trying to make do on a minimum wage job.

Culture warriors have destroyed people’s connection to religion. They have undermined the other social institution that binds people together—the military—and have done significant damage to marriage and family.

Thus, people feel increasingly alone and isolated. They suffer from pervasive social anomie. I suspect that there is more anomie in countries like Great Britain, and even America, than in Italy or Greece. These countries are not doing well... so people must feel more of a need to hang together. In our prosperous nation, people are too full of themselves. They no longer respect social institutions. They feel radically unbound. You are not going to fix it with anti-depressants. You will certainly not fix it with opioids. 


Jack Fisher said...

So many different kinds and anti-depressants perhaps because people respond to one kind and not the other, or because of adverse interactions with other medications?

Do the English have the same definition for depression as here in the US?

Stuart Schneiderman said...

Presumably, they do. To the best of my knowledge most prescriptions today are for SSRIs-- and not the MAO inhibitors or the tricyclics. If anyone knows otherwise please inform us. I think you are aiming at an important point... many SSRIs are prescribed in conjunction with a cocktail of other medications... so the stats are generally a bit skewed. Apparently, if you add all psychiatric medications, the nation that has the highest per capita consumption is France.

Ares Olympus said...

Overall no disagreement here.

I can't guess how many people I know who are on anti-depression meds, but the few I know, if you asked them if it was helping them be happier, I expect their answer would be something different - it helps them get out of bed and to work, so they don't lose their job, and so they can pay their bills, and do the same thing the next day.

And on my crude over-generalized analysis, debt seems to be a large part of the problem, that is to say people in debt have to work harder, second jobs, and so meds help them get their work done, and then they reward themselves by momentary pleasures of spending money they shouldn't, convincing themselves that they "deserve it", while this just keeps them in debt, and keeps them working so hard they need meds to keep working.

This analysis would put 100% of the blame on the people themselves, but they are enabled, and get caught in these cycles (whether payday loans for the ultrapoor, or holding credit card balances for middle class), because these solutions EXIST and WORK, and allow hard decisions on spending to be avoided, and once that habit works for a few years, its a hard habit to break. And even one person who declared bankruptcy a second time, with no credit now, she still works two jobs, and "rewards" herself by consumerism to feel better.

Oh, and to religion, we can also reflect that "megachurches" are the most popular ones, and they're so popular that you might as well stay home and watch the feel good preacher on the television and you can feel better by sending him $5 one week, and a year later find yourself giving 10% of your income to the televangelist, since the volunteer callers are so kind when they ask for more, and sometimes they'll listen to your problems sympathetically, and offer prayers, and sells prosperity gospel promises for future returns on every penny given to God.

I guess cynicism is one defense against depression. How do you tell other people to live below your means when you yourself don't have to?

Sam L. said...

Beats me. I'm not depressed. My buttons are not depressed, either.

Jack Fisher said...

Your shirt's depressing.

Anonymous said...

AO, do you believe anyone on this blog cares whether you disagree or. It?

Sam L. said...

My shirt's neutral, Jack. Why you dissin' my shirt, Huh? You can't even SEE my shirt, so it's all in YOUR mind, and not on MY back, Jack! Unless you had some other shirt in mind. In which case, all is forgiven.

Jack Fisher said...

Sam, your wardrobe talk about you.