Rise of Antidepressant Consumption

Over the course of the last decades, antidepressant therapy has grown immensely all over the world and in Türkiye due to a complex interaction of social, economic, and determinants of treatment of mental illness. Up to 2024 statistics indicate that antidepressant use rates are far beyond imagination in many countries. Iceland is currently leading the world with a rate of approximately 157.3 defined daily doses (DDD) per 1,000 citizens, followed by Portugal, United Kingdom, Canada, and Australia. Even though these countries are at the forefront of the use of antidepressants, they are not necessarily at the forefront of the happiness list, which indicates that antidepressant use is not based on subjective well-being.

In Türkiye, the rise in the prescription of antidepressants is even higher. Prescription of antidepressants has risen by 75% in the past decade, and over 65 million boxes were sold in 2023 alone. The rise is attributed to the impact of economic instability, civil unrest, and the aftermath of massive events such as natural disasters and the COVID-19 pandemic. The Turkish health system, as with most, is always dependent on pharmaceutical intervention, and antidepressants are a standard prescription for those suffering from mental illness. Experts believe that the rise in the availability of antidepressants as well as the reduction in stigma for mental illness has put treatment within the reach of more people.

A variety of reasons can be understood for the increased use of antidepressants. Socioeconomic stressors in the guise of unemployment, financial crisis, and economic uncertainty in the long term in the majority of nations are some of the risk factors for the causation of mental illness. Where mental healthcare is poor, antidepressants are the most used form of treatment. As a result of reduced stigma of society for mental illness, patients are coming forward to be treated and antidepressant prescriptions are on the rise. Pharmaceutical industry promotion has also contributed, as the pharmaceutical industries sold the doctors into prescribing more.

However this second increase in prescribing has come with controversy around how effective the drugs really are and the society-wide implications that follow. While antidepressants should be prescribed for severe and moderate depression, doctors are cautioned by experts against their use in cases of mild depression. Critics of the drugs accuse antidepressants of being prescribed like a band-aid, rather than dealing with the root of the mental disorder. There has been a warning about the drugs' long-term side effects like mental impairment, sexual dysfunction, and emotional numbing that has been overlooked with the eagerness to prescribe. In Türkiye, abuse of antidepressants indicates that the problem is not as much a matter of curing the source of mental illness as it is one of medication. Money disparity, isolation, and lack of mental health care infrastructure are to blame for the number of antidepressants prescribed. For every prescription written, the overwhelming majority of mental health professionals feel more wholeness needs to be added. Medication is an integral part of the solution but can never be enough on its own. Treatment, lifestyle modification, and establishment of healthier social webs of support need to be part of the total response to counteract mental health.

The consumption of antidepressant medication is also highest after the COVID-19 pandemic, and depression and anxiety took their toll on the world due to the pandemic. Lockdown, social isolation, and fear of the unknown resulted in a surge in mental disorders, and the consumption of antidepressant medication increased similarly. In Türkiye, the pandemic witnessed studies indicating that almost 40% of the population developed depressive symptoms and more than 25% developed anxiety. The mental health impact of the pandemic has been prolonged, and most remain on antidepressants as a way of coping with the uncertainty and stress of everyday life.

Looking forward, all experts are agreed in their view that to address growing use of antidepressants, mental health must be addressed holistically. This is by integrating medication with psychotherapy, lifestyle change, and community interventions. Governments and health systems must invest in prevention and public health strategies for mental wellbeing and resilience. More focus must be put on social determinants of mental wellbeing such as poverty, education, and employment, which remain the source of growing depression and anxiety. Lastly, while antidepressants are a necessary part of the treatment of depression and other related conditions, their increased use is also a sign of a deeper malaise in society. Increased use is a sign of issues of underlying problems in mental health provision and the need for an integrated solution that addresses individual and societal determinants of mental illness. As global discourse around mental health continues to evolve, it will be required that policymakers, clinicians, and society in general come together to ensure access not just to pills but to counseling, support groups, and services required to maximize overall mental health.