When did you last pop a pill? I’m not talking about the occasional aspirin for the occasional headache. I’m talking about a pill that might make you feel happier, less depressed, maybe all of the time. A ‘pill for every ill’.
That’s the phrase used in an open letter just published in the British Medical Journal from the newly formed ‘Beyond Pills’ All Party Parliamentary Group. The letter raises an issue that is worrying not just parliamentarians, but an awful lot of doctors and psychologists too. And also many of their patients.
Over the past decade the number of prescriptions issued every year in England alone for antidepressant drugs has almost doubled. In 2011 it was around 47 million. In 2022 it was 85.6 million. That’s roughly two prescriptions for every adult. Allowing for all those who have never had such a drug the conclusion is obvious. A staggering number of people are now relying on antidepressants to help them cope with their lives. But in all too many cases they achieve the precise opposite. Are you one of them?
The open letter has been signed by a wide-ranging group of eminent medical professionals who believe the increase in the number of antidepressant prescriptions is ‘not associated with an improvement in mental health outcomes’. Instead, it’s ‘making an already serious situation even worse.’ That’s because they are being given to patients for minor conditions that could be treated just as effectively with changes in lifestyle or some therapy. It calls for an end to the ‘pill for every ill' approach and the establishment of a national, 24-hour prescribed drug withdrawal helpline and website
The group’s co-chairman is the former chief executive of NHS England, Lord (Nigel) Crisp. He calls it ‘a clear example of over-medicalisation, where patients are often prescribed unnecessary and potentially harmful drugs instead of tackling the root causes of their suffering'.
According to the experts there’s another problem too. Perhaps ‘crisis’ would be a better word. Once somebody starts popping the pills, it is very hard to stop. For some patients it’s virtually impossible. They become dependent on them. This is not because the drugs themselves are addictive in a technical sense. They’re not like heroin, for instance. But with most of them there are often severe withdrawal symptoms. They include disorientation, mood swings and other debilitating symptoms such as tinnitus, so-called 'brain zaps', muscle pains and nasty flu-like sensations.
Somebody who has experienced all this for herself is Sarah Vine, the Daily Mail writer and former wife of the cabinet minister Michael Gove. She was prescribed antidepressants almost fifteen years ago. In a powerful column in the Mail she describes how she has tried repeatedly to ‘wean’ herself off them – and mostly failed. She concedes that she has had some success in that she has managed to greatly reducer her dosage, but every time she has tried to quit altogether she has experienced all the symptoms described by Lord Crisp and his colleagues and, like so many others, found very little help.
But why should so many more people be relying on drugs to help them deal with life’s problems than, say, a generation or two ago? In many ways, surely, we have an easier life than our parents or grandparents. Vine offers an intriguing answer to this question. She says it is not just the patients for whom the pills have ‘become a crutch’. It’s the doctors too. The medical profession has become over-reliant on them because they represent a quick answer to a complex problem that GPs don't have the time or the resources to properly address.
Like most of us, Vine recalls a time when we patients would each have access to one family doctor. We would get to know the doctor and the doctor would get to know us for most of our lives. We would develop a relationship with them. They would come to know us not just as a ‘set of symptoms’ but as a person. Those relationships, she writes, were crucial to helping people in times of personal crisis. A good doctor would know if Mrs Bloggs was simply having a bad day or something more serious was afoot.
That, sadly, is no longer the case. As she points out, many patients rarely see the same doctor twice in a row (assuming they see them at all), and when they do, they have only ten minutes to explain their symptoms. How is a GP to know whether the person in front of them is clinically depressed, or just in need of a pep talk and a couple of days off work? After all, diagnosing mental health problems is not as simple as spotting a broken wrist or an infected cut.
It’s hard to argue with any of that, but those of us of a certain age will remember a time when it was vanishingly rare for someone with mental health problems even to consider seeing a doctor about them. I recall my incredibly hard-working father going through a very difficult period when I was a small boy. He was a self-employed French polisher and too many of his customers had not been paying their bills. Putting enough food on the table had become a real struggle – so much so that he woke us all up one night screaming. We’d never heard anything like it in our young lives.
He was experiencing what we called in those days a ‘nervous breakdown’. It was horrible. But the idea of going to the doctor was unthinkable. The general attitude – certainly in a poor working class community like ours – was that you had to ‘pull yourself together.’ Obviously serious mental illness was recognised and dealt with to the best of the medical profession’s ability but the notion of ‘mental health’ being spoken of in the same way that we might speak of a head cold was yet to be born.
Some believe we have taken it too far – particularly when children routinely pronounce that their ‘mental health’ has been ‘impacted’ by what might once have been regarded as a relatively minor irritation. But the other side of that argument is the huge benefit of destigmatising what may be real life-changing problems, such as serious depression.
My father would have been ashamed to admit that he had ‘broken down’. He never even referred to it in the presence of us kids. But the big question today is whether the pendulum has swung too far in the opposite direction.
As Vine puts it: ‘It's important not to confuse the normal ups and downs of daily life, the inevitable highs and lows, with more serious mental health issues. It's up to medical professionals to spot the difference. But there does seem to be a growing expectation that happiness can be a permanent state of mind, which is impossible.’
That expectation is precisely what the open letter to the British Medical journalist challenged.
Vine herself she is careful to draw a clear distinction between needing a bit of medical help to get through the sort of difficult period that we all encounter from time to time and her own emergency. ‘I could barely move, I couldn't focus or concentrate, I was in constant physical pain — simply getting out of bed in the mornings felt like climbing Kilimanjaro. My nerves were so frayed even performing the simplest of tasks seemed to present an impossible challenge, and no amount of yoga or reflexology — or, for that matter, chocolate (self-medication is often a feature of mental health problems, and my drug of choice was food) — seemed to help.’
In the end she agreed to start taking antidepressants. And they worked: ‘The old me that I had feared lost for ever gradually returned, and with her some semblance of normality. It was like a raging storm that had finally passed.’
So in one sense they were a lifesaver – but only for a time: ‘The problems that made me feel that way in the first place never went away. Indeed, if anything, they got worse, because now I was numb to them. In the end, I had no choice but to deal with them. By then, of course, they were much bigger and badder than they would have been if I had faced them down initially instead of relying on chemicals to keep going.’
So her conclusion? Antidepressants can succeed in making people feel better about the underlying causes that are affecting their mental health but they can’t change those underlying causes per se: ‘The only way to do that is to work out what's causing the depression in the first place, and deal with it. And that requires time, patience, perseverance and, in most cases, money — a luxury not many people have.’
As someone who writes from bitter experience, she approves of what the open Letter to the BMJ is trying to achieve. Let’s put in place mechanisms to help people come off antidepressants and avoid unnecessary use in the first place.
But she adds a caveat. Let us be mindful of the fact that when antidepressants are used properly they can help an awful lot of people through some very tricky times.
Where do you stand? Have you ever had resort to taking antidepressants and, if so, did they work for you? Do you believe that too many are being prescribed with too little thought to the consequences?
Do let us know.