Too many people are being prescribed antidepressants to deal with stressful life events or social problems, according to a growing chorus of doctors and researchers.
More than 14% of Australians are currently taking antidepressants, one of the highest rates in the world. Dr Matt Fisher, who researches wellbeing and the impact of stress, says while he has heard health workers talk about this “as a good thing, because it means more people are getting access to help”, he doesn’t see it as a success story.
Fisher, a senior research fellow with the University of Adelaide’s Stretton Institute, is concerned Australia’s high use of antidepressants “constitutes a failed attempt to medicate away what are, in fact, social problems”. He says while “antidepressants may be of benefit to some people suffering persistent psychosocial distress,” they should not be the default, first response.
Chronic stress, where people are exposed to an ongoing, recurrent stressor without any easy or accessible way to resolve it – increasing the risk of isolation, exclusion, humiliation and harm – is a significant driver of mental distress in Australia, including depression and anxiety, Fisher says.
The common causes of chronic stress include things such as being in debt, having a low income, poor working conditions, or being exposed to racism or domestic violence.
In his book, How to Create Societies for Human Wellbeing, Fisher argues that current policies in Australia are contributing to these toxic social conditions causing chronic stress, in turn leading to high and growing rates of psychological distress such as depression.
It is the kind of stress that cannot be medicated away, he says, and that governments are failing to address.
And while wellbeing “does have significant political currency” at the moment, Fisher says, he believes the initiatives proposed by governments to promote wellbeing fail to recognise social problems and chronic stress as a root cause of mental ill health.
It means policies to address wellbeing too often focus on the individual, encouraging people to be more resilient, to exercise more, to eat better, to see a doctor, to get therapy, or to take antidepressants.
These medical and pharmacological-focused solutions might be helpful for some but do little to help with the kind of chronic stressors that drive ill health, Fisher says, such as toxic workplaces or insecure housing.
“Governments evade the problem by persisting with individualised, medicalised, drug-based strategies,” he says. “These strategies aren’t reducing high rates of mental distress, sometimes do harm, and marginalise attention on social causes.”
Some of this harm was evident when Guardian Australia invited readers to share their experiences of being prescribed antidepressant medications, receiving almost 800 responses.
When Jackie, from Darwin, was 15 she became depressed after being bullied at school. When she told her GP of these problems, she was prescribed antidepressants.
“I felt like I was the one who had to be ‘fixed’ for not being able to endure [the bullies’] torment,” Jackie, now in her 20s, says.
A significant number of people reported being prescribed the drugs for stress that was driven by a difficult life event such as divorce or the death of a loved one, or for chronic stressors such as poverty or neglect.
It was these readers who were most likely to say that they wished they had never been prescribed antidepressant medications in the first place, and that the drugs had ultimately harmed them.
The president of the Royal Australian and New Zealand College of Psychiatrists, Dr Elizabeth Moore, says while depression often coexists with life stressors, “it’s crucial to distinguish between social challenges and clinical conditions”.
“While more people are seeking help and mental health stigma is decreasing, barriers to accessing psychological treatments – such as long wait times, high costs and limited availability – can make medication the default option. It’s easily dispensed, often subsidised, and therefore affordable for many,” she says.
“Many times, prescribing antidepressants may be the only available option to manage conditions, even though non-pharmacological treatments are more suitable but harder to access.”
But Dr Mark Horowitz, who co-authored the Maudsley antidepressant deprescribing guidelines, says it is not acceptable to prescribe antidepressants as a stopgap measure in the absence of accessible, affordable social and other services. He likens it to prescribing someone antibiotics to treat a viral infection, despite knowing antibiotics only work against bacteria but are useless on viruses.
“I think a great disservice is done when we falsely classify social problems as medical problems,” Horowitz says.
“Just because that social condition is a tough problem, it does not mean we can get out of it by pretending it is a different sort of problem and offering people antidepressants.”
In 2023, the UK’s National Health Service (NHS) in England announced an initiative to move away from the “pill for every ill” approach, funding non-pharmaceutical alternatives for mental health and providing long-awaited deprescribing services to help people stop taking antidepressants.
It was in part a response to a review by Public Health England, which found increasing rates of inappropriate antidepressant prescribing was only exacerbating mental ill health. “Medicines associated with dependence or withdrawal symptoms can harm patients if they are prescribed inappropriately; affecting their physical, emotional, social and sexual health,” the NHS found.
This was the case for Simon, of Brisbane, who was prescribed antidepressants about 15 years ago when he was 22 and his father was dying from cancer. Along with grief, he was suffering from domestic violence. Then, his mother also became ill.
But instead of helping him, he found the antidepressants led to him losing motivation, numbing him. “I lost all motivation to do anything and lost my job, and after my mother died I started having many days of just never leaving the house and I became almost a recluse,” Simon says. “Antidepressants make me complacent with doing nothing and the lack of activity is far worse than the depression I had.”
Prof Orla Mundoon, an author and social psychologist with the University of Limerick in Ireland who examines how social contexts can shape behaviour, says experiences like Simon’s “are a global phenomena”.
“We are overmedicating people,” she says. “Westernised countries, in particular, perceive distress or feeling unhappy with life as originating within people, and as caused by a neurotransmitter malfunction. This ignores the key cause of unhappiness for most of us, which is stress and trauma.”
Talk therapy, group-based social supports and exercise are as successful as antidepressants for all but the most severe cases of depression, Mundoon says, something she believes is not clearly communicated with patients enough at the time of prescribing.
Like Horowitz, she does not believe that it is reasonable to prescribe antidepressants in response to pervasive stressors, even as an interim measure.
“It pathologises people, rather than helping with the circumstances of their lives,” she says.
Fisher says tackling these social drivers of chronic stress and therefore depression and anxiety requires policies more supportive of families and child development. Maintaining wellbeing also means providing access to healthy, sustainable food; affordable and safe housing; and affordable healthcare and education.
Fisher says this is not to say wellbeing means striving towards a kind of idealised, utopian society – rather, he says, wellbeing is an ongoing process embedded in the ways we live. And while he believes antidepressants may be of benefit to some people and does not wish to demonise them, he says too often they’re “the default, first response”. In the meantime, governments do too little to recognise, resist and change the conditions that do harm.
“The most effective, long-term response to epidemics of psychological distress is to adopt a public health approach to wellbeing promotion,” he says. “Australia needs a major shift in policy orientation away from expensive, remedial, ineffective medical responses to psychosocial distress.”
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org.
