www.guardian.co.uk/science/2011/apr/09/ben-goldacre-bad-science-antidepressants
Apparently prescriptions of antidepressants have been consistently rising.
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Interesting. I'm not aware of the figures and there are many variables.
Obviously growing population size is one. Changes in soicety which have
made it more ill may also be a significant factor. Measuring the illness
in society is very difficult though.
For example how many of those people prescribed antidepressants had
taken them before? Someone told me there's evidence that there is a
natural cycle to mood, a cycle of ups and downs, but the cycle becomes
more intense if antidepressants are used to medicate the lows away. It
would be interesting to see the data of first diagnoses and the age
range. I wonder if the older generation are starting to accept the dogma
of the church of mental health.
Alternatively the shift could be in primary care prescribing practice.
20-30 years ago I think most GPs were still aligned to the biomedical
model so may have been more strict in diagnosing a clinical syndrome but
as time has gone on there's been more acceptance of the biopsychosocial
model of cause. Teaching of clinical diagnosis may also have changed.
The strong evidence for antidepressants and the growing evidence for the
negative prognosis (the social disability stuff which the psychiatry
didn't really think about much) may have shift doctors to be more ready
to prescribe antidepressants for pretty much anything. Early learning is
a big factor in diagnosis in my opinion and relates a lot to what
happens in clinical practice decades afterwards when medical students
become graduates.
Then there's the work on undiagnosed mental disorder. Think it was
Huxley and Goldberg who were thinking about this around the early 1980s.
Their work may have changed what was being taught and understood by
doctors. This may, in part have been what also increased mental health
promotion spending but I'm not sure. I wonder how much of the shift is
people 'recognising' misery as something to go to a doctor about rather
than see a priest or talk to a friend.
Then, of course, there's the effect of mental health promotion. This is
the movement generally pushed by charities to get people to recognise
distress as an illness which needs to be dealt with by a doctor or
therapist. If I remember right it's the mental hygiene movement which
promoted the distress continuum starting in the early 20th century - the
National Association for Mental Hygiene was one of the organisations
which came together to form the National Association for Mental Health
in the UK after the war (WWII). This is a discrete and separate concept
to psychopathology which is the power of the psychiatric homogeny to
arbitrarily apply perjorative labels to types of people and life
experiences (usually justified by the poor application of
neurobiological science to the human condition)..
The continuing change of the paradigm to encompass a large swathe of the
population as well as the funding for mental health promotion to get
more people to recognise mental illness in the community may be as much
of a factor as the nefarious practices of the pharmaceutical companies.
The promotion and recognition of common mental disorders as an illness
and the older GPs who still dominate in primary care so resort to
biomedical methods instead of following the updated national clinical
guidance (as well as the convenience culture people live in, e.g. I
can't be arsed to go for a walk in the park. Get me some drugs.) on
depression may be behind the continued increase in the prescription of
antidepressants (as well as the continued advertising to prescribers by
the drug dealers...I mean pharmaceutical companies...often using
unethical evidence-based medicine practices).
It is like we may see GPs prescribing non-pharmocological options in
twenty years as medical students today are coming to understand yet
another way to think about what mental health and illness are. Levels of
depression may increase too for many reasons. It has always fascinated
me that poor/developing world countries have much lower rates of common
mental disorders. Applying the biopsychosocial model to what's going on
there and what's going on in developed world nations might offer better
insights into what are the true causes of the problem. For example is it
the expectations of modern life, the desire created by advertising and
perfect media images, the idea that people have a right to be happy or
the problem that people are fed, clothed and sheltered but have no
purpose and all the wisdom of society usually ends up in care homes or
in psychiatric wards, far from the ever maddening populous who need to
remember what it is to be human.
This is a good idea. Give the people the skills to talk and listen. This
could repair the damage to society caused by the construct of mental
illness by teaching basic therapy skills to the people. This could be
taught to people of all ages. Essential be prepared to support one and
another rather than refer a person to a doctor. And be prepared to
accept help from people when you need it. That sort of stuff.
http://www.psychminded.co.uk/news/news2011/April11/Peer-support-cheaper-and-just-as-effective-as-CBT002.html
Of course I think the idea is rubbish. :-) People need to learn to suck
it up, be resilient and stay silent when their heart is burning with
pain or their sorrow feels unending. It's what I did when I was a kid. I
took a year out before university and travelled from North London to
Farnborough to work. I would wake and it was pitch black and it would be
the same in the evening too when returning from work. It was a 3hr
journey each way. I'd walk about 1.5hrs a day to get home/work to the
station. When I got home I would shut myself away in my room and listen
to music. I would cry but I didn't know why I was crying. Looking back I
remember it was a pretty awful experience and I think my parents were
concerned but I toughed it out. When spring and summer finally came I
felt better - a lot better. The feeling of the spring was so much more
because of the darkness I'd been through.
The resilience might be how I learned to survive the sort of psychosis
which ends up people in a psychiatric ward. I did it without drugs or
help from the NHS and I managed to hold down a part time job even while
my entire reality and consciousness were breaking down and all I wanted
was death. The period of remission was like a kiss from the most
beautiful woman in the world.
I admit I medicate the pain away using drugs which are legal or should
be legal. I think there is much value to this mode of dealing with
emotional pain however there may be a problem of high levels of
psychopathology. However most psychiatrists spend their time sucking on
my chocolate salty balls so I don't give a flying fuck what they think.
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