It was when a clinical psychiatrist expressed her concern at the number of people prescribed antidepressants that I realised it wasn’t just me. She too thought the good people of West Belfast especially unhappy as the data was telling us some 30% of the local adult population are on “happy pills”. You might ask how did we get here and should it be acceptable that a third of any population are taking medicines to improve their mental health?
When I expressed these concerns at a public meeting I was quickly admonished by a community worker. Barely unable to hide his contempt he asked if I hadn’t noticed we had just come through “The Troubles; 30 years of conflict and this is the legacy of that”!
Sadly, for him at least, there is little evidence that “the conflict” had a direct negative impact on the mental health of a large number of people: certain individuals off course have suffered intolerable anguish and are still suffering. But it is ironic that a study in the 1980s, at the height of the conflict, failed to show a higher usage of Diazepam-like medicines in N. Ireland compared to other UK cities including Glasgow. Social deprivation it seems is a greater predictor of poor mental health and psychiatric medicine use. In times of conflict communities bond, people see a higher purpose and mental health improves.
Post-conflict is a different matter. The continuing impact of social deprivation – a considerable problem in all parts of Belfast – is certainly a factor in defining the mental health of a population. But what has happened is cultural rather than medical. Feeling low, feeling down, feeling fed-up is not a medical problem rather it is part of the human condition. Finding an inner resilience is easier for some but can be developed by most. If anything we are failing as a society to support individuals to help themselves and we have opted for a medical solution to get us through.
We have too much medicine in N. Ireland and not enough health and wellbeing. We have been trapped into a medicalization myth: a pill for ever ill and for every ill a pill. This has led us to a point where our population is overdosed and its telling with medicines the fourth most common cause of death. We use 40% more medicines per head of population compared to England. We use 22% more medicines per head of population compared to Scotland. Do we get respectively 40% and 22% better health than these populations. You bet we don’t .
But there is something about our antidepressant medicine use that screams this cannot be right. For a start there’s every likelihood antidepressants don’t work. They are only as effective as sugar-pills when it comes to treating mild and moderate depression but we don’t know as the drug companies, up to now, refuse to release all the clinical trial data.
Antidepressants are designed to rectify “a chemical imbalance” in the brain but again there is little evidence that “a chemical imbalance” is the cause of depression or if antidepressants fix it. Antidepressants certainly affect the brain and this is evident in the withdrawal experienced by those who wish to come off. These unpleasant effects are similar to the low mood experience initially so the patient prefers to stay on the medicines. I would not be stretching things too far to call these drugs addictive.
If this is so why do so many GPs choose to prescribe them? Many GPs practise defensive medicine when it comes to patients reporting signs and symptoms of mild and moderate depression. To do nothing, to watch and wait, which is the recommendation of the Government body the National Institute of Clinical and Healthcare Excellence (NICE), GPs start prescribing fearing censure should a patient attempt suicide for example. And off course it’s easier to be depressed now than it was 10 years ago. The diagnostic criteria – the level of symptoms needed to issue a prescription – sets the bar so low it would catch most of us on a bad day.
There is a way out. The Public Health Agency in its Take 5 campaign gives us the means to improve our own mental health;(1) connect with others, (2) learn a new skill, (3) exercise, (4) give of our time and, if we have it, money (5) be curious about our big exciting world. Yes, I agree this take some personal effort.
If you can’t do it yourself, there is the Mental Health Hub now operational across Belfast supporting individuals to create their own resilience and develop more positive thinking patterns using methods such as Cognitive Behavioural Therapy (CBT). The talking therapies are more expensive than cheap-as-chips pills so we will have to invest.
So there it is. West Belfast people are not especially unhappy it’s a medical conspiracy; we have medicalised feeling down, produced medicine to treat it, altered the diagnostic criteria so most people fit and we have thrown the problem at GPs and given them few real alternatives.
Terry Maguire is a pharmacist in West Belfast