Our reliance on drugs that don’t really even work is preventing us from understanding the root causes of depression and devising new ways—real ways that work—to address them...
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The most famous example of the genre is, of course, Aldous Huxley’s novel "Brave New World," published in 1932. In Huxley’s vision of the 26th century, the drug Soma is used to ensure the obedience of the lower classes of a “perfect” eugenic world where people are bred specifically for the social function they perform.
More recently, in the Christian Bale film "Equilibrium" (2002), the citizens of a totalitarian city-state must take an emotion-killing drug as a means to prevent war. Those who refuse to take the drug, called Prozium, are labeled “sense offenders” and are violently hunted down and sentenced to death by a special caste of “clerics.” Art, literature, and any expression of human emotion and creativity are prohibited.
Science-fiction writers return again and again to these scenarios because they raise fundamental questions about the nature of authority and social control. In doing so, they also ask us to question what it is that makes us truly human.
Would it be desirable to eliminate human imperfection with something as simple as a pill? Would the loss of certain “negative” or “destructive” aspects of our humanity be justified by the net gain to social order and the reduction in suffering? And would it be better to try to persuade ordinary people to surrender these aspects of themselves voluntarily for the greater good, or would an “enlightened” class of rulers have every reason to force people to do so, perhaps even without their knowledge?
The dramatization and the fictional settings shouldn't blind us to the fact that such possibilities are very real. Very real—and very close. Just how close has been revealed by new figures from Public Health Scotland, which show that more than a million men and women, close to a quarter of Scotland’s adult population, are now being prescribed anti-depressants, powerful drugs with wide-ranging effects on mood and physical health. This probably makes Scotland the nation with the highest rate of anti-depressant use in the world. In the United States, by contrast, around 15 percent of adults are on anti-depressants, which is still, by any metric, a lot.
It’s not just anti-depressants that Scots are swallowing in record numbers. According to figures published by the Mail on Sunday, more than a third of Scottish adults are now being prescribed drugs from one of five broad classes associated with mental health issues. This includes a further 200,000 adults taking benzodiazepines, which are prescribed for anxiety and insomnia, and 190,000 who take gabapentinoids. Another 130,000 adults are given so-called z-drugs (such as zopiclone and zolpidem), and more than 800,000 are on opioid-based pain medication.
A situation like this doesn’t emerge overnight. It’s taken decades for Scotland to reach this point. The problem was already bad enough in 2007, when the ruling Scottish National Party (SNP) first came to power, that the government made a pledge to reduce the country’s dependency on anti-depressants. Instead, the figures have risen every year since. By 2010, 630,000 adults were taking anti-depressants, and an extra 390,000 were added over the next 12 years. There’s no reason to believe the trend won’t continue.
Politicians are now asking serious questions. Conservative Member of the Scottish Parliament Maurice Golden told the Mail on Sunday: “The sheer number of prescriptions being issued for depression and anxiety in Scotland is astonishing. The fact it has risen so considerably requires urgent and serious attention from the Scottish Government.
“There was a time when the SNP pledged to reduce the rise in these prescriptions, but it has only ever gone in this direction since.”
So why is this happening? A representative from Scotland’s Royal College of Psychiatrists, Dr. Jane Morris, suggested it may simply be due to increased public knowledge of mental health issues and the treatments on offer.
“We’d like to think public education and awareness of the treatability of mental illness means that more people are coming forward,” she told the Mail on Sunday.
On this view, the number of people suffering from depression would be fixed, more or less: All that actually changes is how many people decide to seek treatment. We’re supposed to conclude, then, that at least a quarter of the adult population of Scotland has always been depressed. You don’t need to be an expert to have serious doubts that this could ever actually be the case. Dr. Morris did at least acknowledge that “increased prescribing may now reflect a rise in Scotland’s need for mental health treatment.”
Getting to the bottom of the problem is likely to prove difficult. And the difficulties are only made more acute by the fact that anti-depressants don’t really work.
The state of depression research is shockingly limited. Even after decades of scientific study, there’s still no evidence that the dominant chemical explanation for depression—serotonin deficiency—is true. And yet the doctors of Scotland, and doctors throughout the Western world, continue prescribing selective serotonin reuptake inhibitors (“SSRIs”) on the assumption that serotonin levels are the issue.
Many studies have shown that anti-depressants are barely more effective at improving mood than placebo. The improvement is so small that some scientists argue it’s really non-existent. Access to these minimal benefits is also unevenly distributed among users. A large-scale meta-analysis in the British Medical Journal, considering data from 232 studies of anti-depressant use dating back to 1979, showed that just 15 percent of users experienced an improvement they would not have derived from the placebo, with the remaining 85 percent gaining no benefit from their use.
Those who should supposedly benefit the most from anti-depressants—sufferers of severe depression, comorbid anxiety, and suicidal thoughts—may actually benefit the least from their use. Most clinical trials of anti-depressants deliberately exclude these people, resulting in misleading claims being directed at the drugs’ main target consumers.
If Scotland is facing an enormous mental health crisis, and there’s no reason to believe it isn’t, anti-depressants are unlikely to be the answer. Their blanket use is just complicating matters further. Not least of all because they introduce a range of unpleasant side-effects, ranging from widely publicized loss of libido and sexual function, to gastrointestinal problems, dizziness, insomnia, headaches, loss of or increase in appetite, and even suicidal ideation and self-harm, especially in the early stages of use.
But, more fundamentally, our reliance on drugs that don’t really even work is preventing us from understanding the root causes of depression and devising new ways—real ways that work—to address them.
This is a textbook case of what the philosopher Ivan Illich called “iatrogenesis,” or “medically caused harm.” In his famous book "Medical Nemesis" (1975), Illich argued that the growing medicalization of society is having the paradoxical effect of making us less and less well. In particular, what medicalization does, according to Illich, is reduce our capacity to respond to our problems of health and well-being in suitable ways.
When we see illness simply as an issue to be solved by technical interventions—with pills, injections, and surgery—administered to us by an anointed class of experts, we lose the ability to see illness on any other terms, as anything else. Like, for example, the product of a mismatch between our nature as human beings, stretching back 200,000+ years, and the very different social world we now inhabit. There’s no pill or surgery that can cure that.
I make the case repeatedly in my work that the modern industrial diet, consisting of more and more processed food, and our unprecedented exposure to harmful industrial chemicals are making us deeply unwell, including causing a precipitous decline in markers of reproductive health such as sperm counts and testosterone levels. I think depression is part and parcel of this too. In the last few weeks, new research has shown, for instance, that consumption of processed food, especially products containing artificial sweeteners, can increase depression risk by up to 50 percent, and that elevated exposure to phthalates, a class of ubiquitous chemicals found in everything from personal-care products to plastic bottles, can significantly increase the risk of post-partum depression in new mothers.
There's still much investigation to be done of what's clearly a very complex issue. But we would be fools not to heed the warnings of the thinkers who have shown us, on the page and on the screen, the dangers of a world of total medication. If we really want to do something about the massive rise in depression, in Scotland or anywhere else, we must face the possibility of a new Brave New World: one in which pills are not the answer to all our problems.
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