‘Prozac nation’ claim as antidepressant use soars

By Bazian

The Mail Online today refers to the UK as a “Prozac Nation,” saying that use of antidepressants “has soared by 500% in the past 20 years”.

The study this is based on looked at trends in antidepressant use and at suicide rates in 29 European countries.

The most widely used type of antidepressants are known as selective serotonin reuptake inhibitors (SSRIs). The current study assessed use of antidepressants as a whole, including SSRIs and other antidepressants such as tricyclic antidepressants and serotonin–norepinephrine reuptake inhibitors (SNRIs).

The study found that in almost all countries, greater increases in antidepressant usage were associated with greater reductions in suicide rates.

However, this study only looked at the population level, meaning it cannot conclusively prove that antidepressants are solely responsible for any changes seen. For example, the changes in antidepressant usage may also be paralleled by general improvements in mental health care that could also be influencing suicide rates.

Other factors may also have an influence, such as economic factors. The researchers did try to take some of these into account by adjusting for unemployment, divorce and alcohol consumption in these countries.

As suicide is a relatively uncommon event, it can be difficult to study it as an outcome in randomised controlled trials (RCTs) which generally include relatively small numbers of people followed for a limited period of time.

Therefore, alongside RCTs and individual level studies such as cohort studies, this type of country level research can help to provide useful additional evidence about the potential effect of antidepressants on suicide rates

Where did the story come from?


The study was carried out by researchers from the New University of Lisbon and other research centres in Europe and the US. The project has received funding from the European Community. One of the authors declared being an advisory board member, consultant or speaker for various drug companies. It was published in the peer-reviewed, open access journal PLoS ONE.

The Mail Online’s headline takes a sensationalist approach – highlighting the “bad news” (countries’ antidepressant usage) while ignoring the “good news” (drop in suicide rates).

However the main body of the story does include both aspects of the findings. It also includes appropriate notes of caution on the findings from a study author. He said that “other factors should not be discounted – such as a country’s economic state, cultural mores and access to psychological services”.

He also notes that “a decline in suicide rates cannot be linked directly to antidepressants, but the evidence in support of them – when used appropriately – is pretty compelling”.

What kind of research was this?


This was an ecological study looking at changes in use of antidepressants and in suicide rates in Europe. The researchers say that a review of ecological studies showed mixed findings about the relationship between antidepressant use and suicide rates.

This type of study looks at information at a population level. That is, how many people take antidepressants in the population and how many people in the population have committed suicide. They then look at whether the patterns are consistent with one having an effect on the other.

However, it does not follow individual people and assess their antidepressant use and whether they commit suicide. This means that while it can provide evidence that the two factors may be related, it cannot conclusively prove that one factor is directly causing the other.

The researchers argue that there are three reasons for these studies being useful:

there is a need to assess the long term effectiveness of antidepressants at the population level, especially due to increasing spending on these drugs – an increasingly important issue as most, if not all, countries are still recovering from the financial crisis of 2007 to 2008

to detect an effect on the relatively rare event of suicide, they estimate that an RCT would need to have 20,000 participants, which may be difficult to achieve in practice

they suggest that using suicide as an outcome in a RCT would be unethical

While these points are reasonable, the limitations of this type of study do still need to be borne in mind when interpreting the study’s findings.

What did the research involve?


The researchers collected data on use of antidepressants and suicide rates for 29 European countries between 1980 and 2009. They used various statistical methods to test whether and how these were related to each other.

The researchers used three sources for antidepressant drug use:

wholesale drug figures from a database called IMS Health and OECD pharmacy

sales data

data from national statistical offices

published literature

The researchers used a standardised measure of antidepressant use between countries so they could be compared.

This involved converting prescriptions to a measure called Defined Daily Dosage (DDD). DDD gives a rough estimate of use of antidepressants and the proportion of the population receiving treatment with a particular antidepressant on a daily basis. Some countries had data available for longer periods, and some for shorter periods.

The researchers obtained data on suicide rates from the World Health Organization’s (WHO) Health for All European Mortality Database (WHO-MDB). They assumed that countries’ data collection methods had stayed the same over time. The measure they used was a standardised measure called the Standardised Death Rate (SDR), which takes into account differences in the populations being compared.

They collected data on alcohol consumption, unemployment and divorce rates from the WHO Global Information System on Alcohol and Health, WHO European Region Health For All Database, and OECD Social Indicators databases.

They also looked at the relationship between alcohol consumption, unemployment and divorce rates and suicide rates. They also took these potential confounding factors into account when looking at the relationship between use of antidepressants and suicide rates.

What were the basic results?


The researchers found that over an average of 15 years, the use of antidepressants increased on average by 19.83% each year for the 29 countries included in the study. Over an average of 28 years, the standardised death rate for suicide reduced on average by 0.81% annually.

In all countries, except Portugal, there was what is called an “inverse correlation” between antidepressant use and suicide rates. This means that countries with greater increases in antidepressant usage tended to have greater reductions in suicide rates. This was true in the periods 1980 to 1994 and 1995 to 2009. However, the relationship was stronger in the earlier period.

The relationship with alcohol consumption, divorce, and unemployment rates varied between countries, with some countries showing higher rates of these factors being associated with higher suicide rates and some countries showing the opposite.

How did the researchers interpret the results?


The researchers concluded that “suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants”. They say that this “underlines the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide”.



This study has shown that in most European countries, the increase in use of antidepressants over the years has been paralleled by a reduction in suicide rates. This suggests that one could be contributing to the other. The fact that there is the same pattern across 28 European countries does support a relationship between the factors.

However, as this study only looked at the population level, that is, did not find out whether the individuals taking antidepressants were less likely to commit suicide, it cannot by itself conclusively prove that antidepressants are solely responsible for the change seen. For example, the changes in antidepressant usage may also be paralleled by general improvements in mental health care, which could be influencing suicide rates.

There are also other limitations, which the authors acknowledge, such as the fact that the figures for antidepressant prescriptions may not fully represent antidepressant usage by patients, and that antidepressants may be prescribed for causes other than depression. The study also cannot look at unsuccessful suicide attempts.

As suicide is a relatively uncommon event, it can be difficult to study it in RCTs, which generally include small numbers of people followed for a limited period of time. Therefore, alongside RCTs and individual level studies such as cohort studies, this type of country level research can help to provide additional evidence about the potential effect of antidepressants on suicide rates.


How I got over depression

By Beef_Noodles

I feel like I have a duty to share what helped me, since I am no longer feeling depressed. I had tried many things during this period of my life to get through. I actually became obsessed with ways to get over depression, I took it up as my interest during this time. Basically what was happening was that I was unable to enjoy the things that I once did, the world just seemed empty and my life was purposeless and painful. I had trouble sleeping at night. I had all the classic symptoms.

My mind is very logical, and any solution that seemed too subjective I almost immediately tossed out the window, although of course there are things that help that are very person specific, I’m more concerned with objective methods.

I don’t know if the method I used is unique at all, but it was the way I looked at it, the realizations that I had that made me understand that this would work, and how I explained it to myself.

I heard about the “Tetris effect” a little while ago in a positive psychology book I was reading, it basically states that the human brain will purposefully look for patterns it sees in the world that it has become accustomed to paying attention to. Hence you look at something, and your brain wants to know “how does this relate to the things that are currently going on in my head”. From this I learned quickly that if I had negative thoughts floating around, it would be something negative that I would notice about everything.

I watched my thoughts very closely around this time, and I began to notice that, even though it appeared like I had control over my thoughts, I didn’t really have as much control as I had thought. Just in the time it took for me to get out of my car and start work I had already contemplated the purposeless nature of my life and the universe at large, and my certain death and how empty I felt, how I had nothing to look forward to, how I had nothing to entertain me. Over and over, in a sort of endless thought loop that happened so fast I couldn’t stop it.

I learned that my mind was like an echo box, whatever thought I entertained stayed, and thoughts I neglected to have never surfaced. These topics trended in my mind like the latest fashion trends.

People told me “don’t worry” but in my mind that was impossible, and I’d spend the next 10 minutes thinking about how impossible it was, and how I had no control over my mind, and ugh, the dark beast just loomed over me continuously.

So, from what I had learned about my mind, I started to forbid certain thoughts from entering my mind. This was difficult considering that there were about a thousand different negative thoughts and feelings in my head at any given time. It took awhile, when I first started I might have been half way through a negative rant with myself before I decided to turn my attention to what I was doing. After awhile it seemed like I’d notice my negative thoughts much quicker, when a thought would enter my mind, it would immediately come attached to the idea to “let this thought go”. It’s like my brain learned to associate negative thoughts with the idea to let them go.

Now, pushing away a certain thought isn’t like it sounds, trying to not think of something just makes you think of it more. You have to propel your attention onto something else.

This took about a week to clear up completely, days would end and my progress would stay intact in the morning. Had I not realized the logic behind this simple method of “don’t let yourself have negative thoughts” I would have just lost faith in such a ridiculously simple and initially ineffective technique. I feel like for a lot of people such a thing doesn’t work because they either don’t have faith in it, or they discount it because it will most definitely not work over night, which leaves them with even more doubt and negativity.

As time went on I began to realize that everything was grabbing my attention more, and everything was more fun and engrossing than it had been before.

Another important thing, try to stay busy with things that you at least somewhat enjoy, or at least take up your mind. I know it’s obvious, but you are much more likely to have negative thoughts when you are sitting around doing nothing. I used the activities I was doing as something to latch onto when I pushed away the thoughts. I highly recommend anything that involves reading, because it takes a lot of attention to read, or listen to someone speaking.

The most important thing I’ve learned is that the greatest predictor of my mood is not really what is happening around me (although it certainly has an effect), but what is going on inside my mind.

What is it like to be in a relationship with someone who has ADD/ADHD?

By Anne Halsall

I’m currently in a LTR with someone who has ADD. So is my partner. 😉 The fact that we are both ADD certainly helps us understand each other better, but there are definitely things about it that can be difficult for both of us to cope with.

Here are a few things that come to mind:

Periods of hyperfocusing may take your partner’s attention away from you. If they are obsessed with building model planes that week, it will cause them a great deal of frustration and angst to do anything other than building model planes. Give them space when this happens, but also set clear expectations about when you need them to put the hobby down for a while.

Flakiness can definitely be an issue. Sit them down and have a conversation about how hard it is to trust someone who doesn’t do the things they say they will. A far preferable situation is for your partner to be realistic about what they can and can’t manage given their disorder, and to be upfront about it when they probably can’t do something. The flipside of that is when they do say they will do something, they had better actually do it!

Being ADD is very frustrating and sometimes can cause bouts of depression. Recognize depression for what it is (it’s not a failing or a rejection of you) and try to be emotionally supportive. Generally what a person needs most in that situation is a hug and an “it’ll be okay.”

Your partner may have a tendency to multitask compulsively, i.e. check their phone while talking to you, always have a laptop out, etc. They may even get distracted and stop listening to you or trail off mid sentence. If this happens in a situation that is inappropriate, say something about it in a firm but not accusatory tone.

There are some good things too! It can be really fun and stimulating to be around a person who’s mind is going at a mile a minute. My partner seems to know everything that’s ever been put on Wikipedia and drops awesome random facts all the time. It’s important to embrace the good things about your partner since ADD at least plays a part in the person they are.

Addendum: After thinking about this some more, there are a couple of really important points I would add. First, your partner may or may not be taking medication for their disorder. Certain things may be easier for you if they are, but this does not mean you have the right to expect or pressure them to take medication. It is a choice every individual must make for themselves.

Second, ADD/ADHD is not and should not be an excuse to be a bad partner. Likewise, you should not blame every mistake they make in the relationship on their disorder. Try not to frame your discussions around the disorder, but instead focus on the behavior that is bothering you, which may or may not be related to the disorder.

Can suicide be justified under ANY circumstances?

By  Prasanna Rajagopal

Why not?

I see a lot of BS going around about ‘life being a gift’ and all that. Let’s stay factual, shall we? Nobody gifted you life. You are the result of evolution and part of a civilization that is, for better or for worse, very fast and very competitive. But shed no tears, for nobody cares. It’s just evolution again – survival of the fittest.

The question ‘why’ about suicide is a tough thing to answer, because people are varied and they have different lifestyles. Sometimes it’s loss, sometimes mental anxiety. The list goes on. Students commit suicide because they are afraid to face the world. The transition from the cheerful, blue-sky world to the harsh reality is not accomodated by everyone and some die.

To anyone thinking about suicide, I’m not saying it’s wrong. Nothing is wrong anyway. If someone close to me kills themselves, it’s going to be sadder than if they had died because of some other reason. Any other reason. I would feel worse because I could have solved her/his problems and maybe she would have seen life in a different light. Maybe I should have noticed that the person wasn’t the same. Maybe I was too busy doing things that may seem trivial after that person’s death. I don’t know. But there might a chance that she/he could have lived and I failed my part in it.

Justification – nobody needs to justify why they are dying. Death is as natural as life and it’s high fucking time our society realises this. Life is important but let’s not force it. Some people may just be tired of life and the living. If you are going to stop someone from a suicide then you are taking the burden of helping them live. And it is a burden. One cannot live happily for someone else and you certainly cannot convince them that life is worth it.

So, is suicide okay? Yes, it certainly is. Should you take a chance to stop someone from doing it? Definitely. More living is certainly better than more dead, economically, socially and for a better future. Their talents might be of dire need someday.

Then again, you stop someone from committing a suicide, you better give them a reason to live ’cause they’ll try dying again if you don’t.

How do I cope with severe depression?

By Erika Tabke

I’ve had serious, horrible depression (recovery can be a long road but it’s worth it) and my best friend committed suicide many years ago and I still think about him every day.

You are balancing a huge number lot of stressors; working on a PhD, living in a foreign country, struggling financially, your relationship ended … honestly and in all seriousness, I want you to know that you’re going through a lot.

You said: “The only reason to be alive is that my family feels emotionally dependent on me.”

YOU ARE WRONG. Your family loves you, and would be absolutely devastated if you were to kill yourself. You have friends and acquaintances who like having you around. You dated someone for four years; you may have broken up but you mean a lot to him and have influenced a big part of his life. And I’m guessing you’ll have several answers here and you’ll learn how much we like you and we’re just barely getting to know you.

Please do not kill yourself! I know that when you’re hurting, there comes a point where the pain in your head and heart are so overwhelming that suicide feels like the only way to fix things. I know this feeling, and I promise you that if you stick around, it will get better.

You mentioned seeing a therapist every few weeks and that you can’t afford more treatment. Talk to the school – universities often have good psychological healthcare resources for students. If you have no luck there, there are other social service agencies that can help. And many, many therapists charge fees on a sliding scale depending on how much you can pay. The biggest task you have right now (and the best thing you can do) is find a therapist you can see more often.

Have you been treated for your depression with antidepressant medication? This is an option that can really help enough so that you don’t feel completely buried alive. There are a lot of medication choices and a good psychiatrist can work with you to begin feeling better pretty quickly. And you don’t have to stay on antidepressants forever, so don’t feel like you’ll be stuck on them.

I live in Austin – if you live here too, please send me a PM here on Quora and I’ll find some leads for you. (I see my therapist tomorrow morning … she’s networked all over town and I’m sure she can give me a list of resources for you.) I know nothing about other parts of Texas, though, so I’m not much use for finding resources for you if you’re in another city.

Be kind to yourself. Find something – anything – that makes you feel good (even a little bit). Rest when you have a headache, but get out in the sunshine and walk when you’re not in pain. You probably don’t have much energy to get out of the house and walk around, but you can make yourself do it, and it will help you feel better.

One more trick that I have used to get through a day is to break up the time into tiny little chunks. I would take a five-minute break from my depression to drink a favorite cup of tea. Then when I put the teacup down, I’d tell myself, “Okay, I can survive the next ten minutes.” At the end of that ten minutes, I’d tell myself, “okay, I can survive the next ten minutes.” And so on. You can make it through the day, a few minutes at a time.

If there is a particular thing that propels you into a darker place (for me, it was being in my kitchen) – a particular room, an item of clothing that reminds you of something painful, music – then get away from it. If you hate your bedroom, go sleep on the couch instead. If classical music makes your head pound, stay away from it. It sounds small, but it can make a difference.

And if you need to, get back on that suicide hotline and talk to the people on the other end of the phone some more. They’re there for you and they care about you and they will talk to you for as long as you need them to!

Please take care of yourself. Please don’t kill yourself. Keep reaching out for help – help will be there for you.

Hiding Mental Illness From Others: How do you do it?

By Jesse Lashley

For me, it is easy.

I’ve always been a private person, almost to an extreme. There are small, unimportant, and insignificant details of my life that I’ve hid from people close to me for no good reason.

This wasn’t a small and insignificant detail. But, since I had all those years of experience not letting anyone know what I was thinking, it felt natural to extend that to mental problems. So, I did.

I’m a great liar. Sometimes I tell jokes, and I deliver them so deadpan that no one quite knows if I’m joking or not. I can do that with anything; I sound exactly as sincere as I want to sound. All of this served me well when it came to putting on a show.

Also, I was easily able to rationalize my odd behavior. If I slept all day, woke up in the evening, and immediately went back to sleep, it was because I was a teenager, and teens need more sleep. If I lied and faked headaches to avoid going out in public, it was just because I was introverted. If I forgot numerous things that I should have easily known, it wasn’t that strange, everybody forgets stuff now and again. If I got deliriously hyper, I was just having a good time. If I tried to read my Physics book over and over before realizing hours later that I hadn’t read a single page, I was just bad at science or tired. If I suddenly cut off contact with old friends, I was too busy to talk.

This is how I faked it to myself. I built a character of a Jesse who was perfectly normal. Maybe a little eccentric, but there’s nothing wrong with eccentric, right? Telling myself that I was fine, even though I had known better for years, put me in the right mindset to act like I was fine.

And it was flawless. A seven year performance, and not a single soul realized that they were seeing an act. Everyone who knows about it now said that they almost didn’t believe it first; I looked perfectly happy.

So, how does it feel? It feels like you constantly want to tell somebody. You play out little sequences in your head of talking to someone, really, anyone. But you won’t, because there is something else in your head, something that will shut you down as soon as you start thinking too seriously about it.

What does it feel like when you’re depressed and someone tells you to “remain positive”?

By Erica Friedman

It feels irrelevant.

Depression is not how one feels, it is how one is made to feel by the chemical cocktail in one’s brain. When the chemicals are out of whack, being told to “cheer up” is as relevant as being asked to “go out and have fun” when one has a high fever.

In the bigger picture, not everyone understands depression – and not every depression sufferer realizes they are depressed.

Most people with whom we interact on a day to day basis are casual acquaintances, not close friends. They may have no idea we are depressed – and if they do, their coping toolbox may be small and inefficient. Forgive them for not suddenly being capable of dealing with your crisis, it’s not theirs. They are doing their best, however meaningless it is to you.

OTOH, you could try to give them useful tools to assist you. Tell them what you need them to do or to not do and ask them to help you by doing or not doing those things.