From sleeping and tranquilizer pills to antidepressants: the use of psychotropic drugs among the Belgian population has been extremely high for years. Just about 25% of Belgians turns to medication to get through the day and/or night. Chronic use is particularly worrying. For many, the first prescription paves the way for years or even lifelong pill-taking.
In addition to the rise of so-called benzodiazepines – drugs for anxiety and insomnia – antidepressants are also widely sold. Sun 13% of adult Belgians is prescribed, but children and young people are also increasing their use. By 2022, no less than 60% more antidepressants prescribed to 12 to 18 year olds than in 2018.
In 2022, 60% more antidepressants were prescribed to 12 to 18 year olds than in 2018
To curb the overconsumption of psychoactive medication, the Minister of Health launched Frank Vandenbroucke (Forward) a few weeks ago the country Psychotropic drugs: what risks do your patients run? Together we ensure appropriate use. This action is primarily aimed at healthcare professionals and rightly emphasizes the risks and (often serious) side effects of the drugs.
The importance of psychoeducation is also underlined in the campaign: correctly informing patients and those around them about the nature and causes of psychological problems and about the possibilities and limits of psychotropic drugs.
That is also desperately needed. As it turns out national in international research that the (excessive) use of psychotropic drugs is fueled by an outdated, strictly medical view of psychological unwellness. Anyone who is convinced that the cause of psychological unwellness lies in genetic predisposition or a chemical imbalance in the brain simply turns to pills more easily and… is inclined to use them for longer.
In particular, the idea that depression is rooted in a deficiency of the ‘happiness hormone’ serotonin continues to exert an irresistible appeal. However, that theory hardly exceeds the level of one urban legend and there is hardly a care provider who is willing to lend a helping hand.
However the view continues to be rampant to the general public. This contributes to the (over)consumption of antidepressants. The gap between what laypeople believe about depression and what science has (not) to say about it remains very large.
Anyone who wonders why this happens ends up in a tangle of social, cultural and market-driven motives, which science quickly falls short of.
The birth of a myth
Despondency, even of the debilitating kind, is as old as man himself. At times it was seen as a spiritual problem or even a form of possession, at other times as a physical ailment caused by an excess of black bile.
The arrival of biological psychiatry in the nineteenth century once again ushered in a new framework of thought. The terminology shifted from melancholy to depression and doctors and psychiatrists frantically searched for a biological cause.
Even before the hypothesis about a serotonin deficiency as a cause of depression passed scientific testing, scientists started talking about ‘the happiness hormone’
In the second half of the twentieth century scientists discovered by chance that administering the substance serotonin has a beneficial effect on the mood of some – but not all – people. Without a doubt an interesting observation or at least worth investigating further.
The conclusion seemed irresistible in its simplicity: a depressed mood is the result of a serotonin deficiency. Depression works a bit like diabetes: due to a deficiency of certain substances. If that is correct, then the remedy is obvious: we administer the missing substance and that is the end of the matter.
However, to prove the serotonin hypothesis scientifically, you still need to be able to demonstrate a number of things. That the serotonin level of people with depression is systematically lower than in people without depression, for example. Or that artificially lowering serotonin levels causes depressive symptoms. Only then would the disease process underlying depressive symptoms be somewhat comparable to something like diabetes.
Advertisements for antidepressants moved further and further away from scientific evidence
Even before the hypothesis passed that test, scientists started talking about ‘the happiness hormone’ and the starting signal was given for the development of so-called SSRIs (selective serotonin reuptake inhibitors), that artificially increase serotonin levels in the brain. It is still by far the most commonly prescribed class of antidepressants.
The best known is undoubtedly fluoxetine, better known by its brand name Prozac. When that drug came on the market in the US in 1987, no one had it can foresee its success. People flocked to the drug, with forty million users worldwide by 2002. This generated a turnover of $22 billion.
In the often aggressive marketing campaigns in the United States the serotonin hypothesis was central: someone who is depressed has a deficiency of a substance and antidepressants supplement that substance. A miraculous solution to a serious and widespread problem. Only: those advertisements were increasingly removed from scientific evidence.
Investigation is on the spot
After more than fifty years of scientific research, the hoped-for evidence for the serotonin hypothesis has not been forthcoming. Research results mainly excel in their erratic nature. Depressive complaints do not appear to keep pace with serotonin levels and artificially lowering serotonin does not consistently lead to depressive complaints.
Moreover, the use of SSRIs – in contrast to, for example, insulin for diabetes – produces varying results in patients: for some they make an effective difference, for others they do nothing and in yet another group they lead to a sudden worsening of the complaints. A increased risk of suicide is now included in most package leaflets.
Antidepressants that work on serotonin levels in the brain sometimes do something, but we don’t know exactly what, and certainly not how or why
Also the lack of scientific insight into the precise effect of antidepressants is even mentioned there: “It is not yet entirely clear how […] SSRIs work,” we read, for example, in the package leaflet of the often prescribed drug Serokhat.
How it is that the drugs do produce the hoped-for results for some is now once again the subject of research. Provisional explanations range from a placebo effect, to a general flattening of emotions (and therefore also melancholy), to a kind of shock effect in the brain that has beneficial effects in some people and disastrous effects in others.
The preliminary conclusion is clear: SSRIs sometimes do something, but we don’t know exactly what, and certainly not how or why. By the way, that is by no means a reason to do so pillshaming. Depression can be extremely debilitating and every possible life preserver is welcome.
Due to the large gaps in our knowledge, some restraint is appropriate. Particularly in children and young people whose brains are still in full development, it is not advisable to administer substances whose effects and long-term effects are not well understood.
2023-10-11 05:01:47
#depression #epidemic #myth #happiness #hormone
