Are we prescribing too many antidepressants — or not enough?
A few years ago, the Organization for Economic Cooperation and Development (OECD) looked at antidepressant use in 25 countries and found something startling.
In every single country the OECD looked at, antidepressant use was on the rise.
In Germany, antidepressant use had risen 46% in just four years. In Spain and Portugal, it rose about 20% during the same period. Iceland led the pack in overall use with about one in ten people taking a daily antidepressant — but that figure may underestimate the actual rate of use, since that calculation isn't restricted to just adults.
The United States was not included in the OECD analysis (we've added it to the chart below), but if it had been, it would knock Iceland out of the top spot: 11% of Americans over the age of 12 take an antidepressant.
It's difficult to say exactly what the data tell us.
Antidepressant use is not an accurate window into rates of depression. Instead, the popularity of antidepressants in a given country is the result of a complicated mix of depression rates, stigma, wealth, health coverage, and availability of treatment.
In the United States, for example, only about a third of people with severe depression take an antidepressant. In South Korea, where antidepressant use is the lowest among the countries analyzed, the suicide rate is the highest in the developed world. Koreans are much likelier than Americans to see mental illness as a personal weakness, research has shown, which means many never seek treatment.
According to a review of the research on depression in Nordic countries, Iceland's unusually high antidepressant use is "a result of their perceived effectiveness by users, but also an effect of limited access to alternative treatment like psychotherapy." The rising rate of antidepressant usage there, however, has not been tied to any decrease in suicide rate or disability due to depression.
In fact, the review notes, "the increase in antidepressants consumption has spurred an ongoing debate [about] whether antidepressants are overprescribed (medicalization) or underprescribed (poor access to treatment)."
The OECD suggests two possible reasons the rate of antidepressant consumption is on the rise in so many countries. The course of treatment lasts longer than it used to, and antidepressants are now prescribed not only for severe depression, but also for mild depression, anxiety, social phobia, and more.
Spending long periods of time on antidepressants actually aligns with international guidelines for treatment. The World Health Organization recommends that people continue taking antidepressants at least nine to 12 months after they've recovered. (It acknowledges, however, that the evidence supporting that recommendation is "moderate;" more research is needed.)
Among Americans, 60% of people taking antidepressants have been taking them for at least two years; 14% have taken them for 10 years or more. That seems to match the WHO's guidance, but it hides a larger, more difficult-to-solve problem.
Less than a third of Americans taking an antidepressant have actually had an appointment with a mental health professional within the past year, suggesting a critical weakness in a system where medication is widely available — often prescribed by primary care physicians — but holistic mental healthcare and frequent monitoring are not.