On March 6th, RTÉ published an investigative piece detailing the exponential rise in the percentage of the population that is prescribed antidepressant medication. Conn Corrigan reported that from 2012 to 2017, the prescription of dosages rose by 28% with a yearly average of 31,000. Deriving information from a 2016 study by the Institute for Health Metrics and Evaluation, Corrigan discovered that Ireland (in joint first with Finland), has the highest rate of mental health and substance use disorders in the EU. 19% of the population suffer from such disorders, higher than the EU average of 17%. Such statistics, while initially difficult to consume and recognise when all documented so quickly, have been flagged as worrying – is Ireland plagued with ‘a depression epidemic’?
Antidepressants are prescribed to relieve patients of clinical depression, anxiety, social anxiety disorders and OCD. By boosting the amount of neurotransmitters such as serotonin in the brain, antidepressants aim to correct the chemical imbalance which triggers such low moods, mania and other symptoms. The HSE reassures that 50-65% of people treated with antidepressants see an improvement in their mental health and that the consumption of such medication quells the symptoms of depression and anxiety. While antidepressants are extremely essential to some, others regard them as another example of an increasingly medicalised world which over-prescribes drugs for issues that do not require them. In the RTÉ report, Dr Harry Barry cites misdiagnosis as a leading factor in escalating prescriptions, while Dr John Hillery regards it as a consequence of the heavy influence of the pharmaceutical industry. He recalls a time when ‘money, hospitality and other incentives were used to get doctors to use certain medications,’ perhaps referencing payments of undisclosed reasoning made by the pharmaceutical industry to Irish doctors and healthcare institutions in 2015, each worth €6.8 million and €10.7 million respectively.
While a heavily regulated industry, it is one which is not impermeable to marketing strategies which make the most expensive medicines also the most prescribed ones. While unproven here, this is seen in full transparency and on a greater scale in the United States, where big pharmaceutical companies can lobby politicians to legislate deals which benefit their products and patents which quell competing medicines. In Ireland however, where in recent years we have begun to deconstruct the stigma surrounding mental health. It is important to note that this rapid increase is perhaps not due to a greater dependence on medication or heavy-handed influence of capitalism, but that it is a country slowly coming to terms with the fact that mental health may not be tangible, but it can be as deadly as any other illness when left untreated. In a country where institutionalisation was once the only option for those with mental health issues and ‘insanity’ was once the only word for mental illness, we have come a long way in starting a conversation about mental health. Rather than only answering our friends with some force-of-habit ‘good, thanks – you?’, the idea that it’s okay not to be okay is finally hitting home.
Despite mental health becoming more normalised, and – as a result, perhaps – the medication with which to treat it becoming more normalised, Ireland suffers beyond its means. While therapy and counselling services are the preferred initial alternative to medication, waiting lists make this impossible when the person is in immediate trouble and distress. Without the means to pay for private mental health services, those struggling are left with the option to wait or to be treated immediately with medication. Dr Barry articulated the problem in the report by RTÉ, stating that people are put on medication to ‘alleviate distress in the short term, knowing it might be a while before they have access to those other interventions’ such as counselling. He says that Irish adolescent mental health services in particular are struggling, strained under the ‘sheer volume of people being referred to them.’ In July of 2018, the Mental Health Commission of Ireland outlined that the shortcomings of Irish mental health facilities ‘are so pronounced that they breach the fundamental rights of service users.’ In relation to the mental health of children and young people, the Commission only saw ‘paper exercises’ and breathing practices without any system of recovery strategy.
With inefficient funding and lacking support structures, it is only natural that the first approach should be medicalisation. The conversation surrounding mental health is one which needs to become louder. It needs to put more pressure on the government to increase the funding of mental health services so that help is always available when people need it. Here in UCC, though our waiting lists for student counselling may be long, the recent Student Union elections broadcasted multiple manifestos which featured the pledge to increase services and shorten the wait. With Niteline, students can begin to start their own conversations, taking the power away from the stigma which has plagued the topic of mental health in Ireland in the past. Antidepressants may be the solution for some, and they may just be a short-term fix for others. For the rest, they might never need to be an option. Regardless, everyone has the right to feel okay and to receive help when they don’t. To understand mental health, we have to talk about it.