Chronicle of a fact foretold: The increase in antidepressant prescriptions

There were reports in the media recently about the increase in antidepressant prescriptions over the last decade. Since 2000, this number has more than doubled. Many health professionals, including myself as Psychiatrist-in-Chief at the Douglas Institute, were asked to comment on these seemingly surprising, even worrying, numbers.

Am I surprised?

No. How could I be? For years, observers in the field of mental health have tried to alert the decision-makers and influencers of our society that mental health disorders, particularly depression and anxiety, are causing more and more harm to families and the workplace. We know today that the chances of someone having a mental illness in his or her lifetime in Canada is one in five, and that 8% of Canadians will experience a major depression in their lifetime.1 It is estimated that depression will be the second leading cause of disability in the world by 2020.2 One of the worst scenarios I can imagine would be giving an interview about this situation in 2020 and having someone ask me, “Are you surprised?” This bad dream, however, does not have to come true.

Am I worried?

What worries me is not the increased use of a safe treatment that has been shown to help many people navigate their daily lives. What I do find alarming is how the resources and funding allocated to mental health remain insufficient. Even though mental illnesses pose a heavy human and social burden and exact economic costs that are higher than many physical illnesses combined, they are not given the same attention in terms of health care and research money. For example, cancer is prevalent in less than 5% of the population, but almost 25% of available federal funding is directed to cancer research and care. Mental health disorders, on the other hand, affect more than 10% of the population, but receive less than 4% of health care funding.3 This does not mean we should rob Peter to pay Paul; we should instead recognize that it is possible to do better. What also worries me is the lack of public sector access to other treatments, such as different kinds of psychotherapy, which can be just as effective for mild to moderate depression and can help prevent relapses in cases of severe depression.

Am I alarmed?

Many experts have examined the causes of this situation. It is now essential that we act to stem the tide of human, social and economic costs associated with mental illness. Ten years ago, the toll of mental illness on the national economy was estimated to be more than 14 billion dollars in direct and indirect costs. If the economic argument is what it takes to get things moving faster, so be it.

Mimi Israël, M.D., FRCPC, Psychiatrist-in-Chief at the Douglas Mental Health University Institute and Interim Chair of the Department of Psychiatry, McGill University. Chair of l’Assemblée des chefs de departement de psychiatrie de l’île de Montréal.

1.Quick Facts: Mental Illness and Addiction in Canada, Mood Disorders Society of Canada, 2006
2.Mental Health Policies and Programmes in the Workplace, World Health Organisation, 2005
3.Out of the Shadows at Last: Transforming Mental Health, Mental Addiction and Addiction Services in Canada, Kirby Report, 2006.