The antidepressant wave - why antidepressants prescribing is soaring
Understandably there are a number of concerns about the impact of the Covid-19 pandemic both on rates of mental ill-health and the capacity of mental health services to support those in need. This article attempts to provide an overview of the current landscape.
ONS (Office of National Statistics) data showing that self-reporting of depressive symptoms went up in the Spring and Summer of 2020 compared to the same period in 2019. There have been recent reports in the mainstream press about the high rate of antidepressant prescribing in the context of the Covid-19 pandemic, coupled with reduced access to NHS psychological therapy services.
One valid question is whether there really is a higher rate of depression within society, or whether what this reveals is that we are collectively experiencing greater levels of distress, triggered by a difficult season, which are being mislabelled as depression. We know, for example, that there has been a breakdown of our social networks, which usually help us to overcome areas of challenge in our lives and many people have endured sustained increased stress, limitation and disruption throughout the pandemic.
Although self-reporting of depression is always subject to scrutiny, one thing we do know is that the rate has gone up compared to pre-covid levels. This should not be surprising. The pandemic has affected people in every walk of life and had a huge negative impact on people’s lives. Figures are also influenced by some people who contracted Covid-19 and then experienced ‘Long COVID’, which can include direct psychiatric symptoms, including a low mood. These cases probably make a small yet significant contribution to the increased rates of depression.
In keeping with this, it would seem appropriate that if more people are experiencing depression than previously, the rate of prescribing antidepressants, one of the evidence-based treatments for moderate and severe depression (alongside psychological therapy) would go up.
However, it is important that we do not medicalise distress, which clearly is something many of us have experienced over the last twelve months as our lives have been turned upside down. There are key core features of depression that differentiate it from normal distress – low mood, a lack of energy and a reduced enjoyment of previously pleasurable activities or hobbies - and it is important these are not forgotten. We all experience periods where our mood dips, but in depression the low mood is present on most or all days over several weeks and in some instances will occur throughout the day. Alongside this there may be changes in our ability to concentrate, our appetite, sleep and energy levels.
This is distinct from a so-called Adjustment Disorder, where we experience distress and a low mood in the context of adverse circumstances, such as following the loss of a relationship or major conflict at work - or even global pandemic! - but these do not persist and Adjustment Disorders tend to resolve, either with time or when the stressors are removed.
Such a distinction is important, as in supporting someone diagnosed with an Adjustment Disorder, there is usually not a need for a treating doctor to prescribe any antidepressants. Instead, talking therapy - including counselling - may be offered, or other interventions, such as online resources, apps and books people can access; these are referred to as guided self-help.
On the other hand, with a moderately severe or severe depression, the evidence-based guidelines do suggest that an antidepressant should be considered, often alongside talking therapy.
Doctors are trained to take a holistic view of their patients’ circumstances, to ensure that distress is not mislabelled as depression and thus reduce the risk of overprescribing of antidepressants.
There has been a lot of concern about the mental wellbeing of the younger people in the current context. What we do know is that from studies carried out looking at children’s mental wellbeing during the Blitz, young people are incredibly resilient, provided that they have a stable home. Therefore although they may show some signs of frustration, anxiety and even low mood triggered by the restrictions on their lives, for the vast majority these will not lead to long-term mental illness. Even greater caution is taken by medical professionals when it comes to prescribing antidepressants, which should offer parents some reassurance.
There is one important misconception that needs to be addressed: whether access to support services like counselling has been reduced as a result of the pandemic. Whilst therapists and counsellors have certainly had to adjust (how they work), the vast majority continue to work, just like many other professionals, offering appointments and connection via alternative platforms like Zoom, or telephone counselling.
NHS mental health services, including CAMHS, have also continued to operate throughout the pandemic, and many allow people to self-refer (without needing to be referred by your GP). So, although the way you can get support may have changed, it is important people realise that it is still out there.
Talking therapies, such as counselling, can be a good way to sustain wellbeing through a difficult or stressful period; if you know your circumstances are particularly challenging, it is well worth looking into what is available in your local area or asking your GP whether they can recommend a service that is suitable for you and/or refer you on.
If you are worried that you may be experiencing depression or a loved one may be exhibiting symptoms of depression, or any other significant mental illness, do remember that GP practices are open and they should be regarded as the first port of call to explore what is going on and what can be done about it. If in doubt, do seek help and do so early.
Finally, if you are taking or have recently been prescribed antidepressants, do not be alarmed. Depression is not a sign of any individual weakness or failing and antidepressants are often part of a combined approach to treatment which may have different phases. If you have questions or concerns related to antidepressants you or a loved one are taking, make sure you talk to your GP or the prescribing doctor, perhaps writing them down prior to any appointment as it can be difficult to remember all the key points in the moment. Do not make changes to medication you are taking without discussing this with your doctor and remember: their advice is more specific to your situation than any media article.
Dr Chi-Chi Obuaya is a Consultant Psychiatrist working in the NHS and in independent practice, as well as a Mind & Soul Foundation Director