Antidepressant usage doubles in five years

Figures from the Health Insurance Organisation (HIO) show that the number of patients taking antidepressant drugs almost doubled in Cyprus in the past five years: from 33,470 in 2019 to 64,611 in 2023.

On the one hand, there’s a simple explanation. March 2020 was when antidepressants started becoming available on Gesy – some can even be prescribed by personal doctors – and 2020 was indeed when the biggest increase occurred, a 51 per cent year-on-year rise to 50,461 patients.

Then again, the number has shot up even more since then – and HIO figures only reflect the state system and Gesy, in any case. Private doctors aren’t included – and many people choose to go private, since a certain stigma clings to mental health even now.

Clinical psychologist Anna Papetta estimates that the actual number taking antidepressants could be double the HIO total. Her colleague Evangelos Orphanides told the Cyprus Mail that “as a ballpark figure… approximately 5-10 per cent of the population in Cyprus may be on antidepressant medication”. Given the official figures, even that sounds like an underestimate.

What’s causing this growing problem? And is it, in fact, a problem – or an encouraging sign of people getting much-needed help?

On the first question, the rise in numbers is partly because antidepressants are now being prescribed for all kinds of mental-health issues, not just depression.

Papetta mentions PTSD, ADHD, bipolar conditions, eating disorders, sleep disorders, even Alzheimer’s – not because they treat the condition, obviously, but to reduce aggression and improve mood – as cases where the meds might be employed. Then there’s stress, not depression per se but a close cousin. “Many people,” she says, “are driven to take medication just to feel good.”

That’s the underlying issue: a society-wide increase in stress and anxiety, stemming – most probably – from a lack of interaction and human contact.

Covid played a role here, not just in making people more introverted but also fostering a fear of contact. “If you touch, this will happen. If you talk, you’ll be infected,” recalls Papetta. “People withdrew into themselves.”

But the problem is bigger than Covid. For some reason – technology being the prime suspect – we’ve forgotten how to communicate. Papetta hears of families, for instance, where a parent will text their child to come down to dinner, rather than going up to their room to tell them in person. “Everything happens through a screen.”   

Thirty-year-old Ioanna (not her real name) agrees: “We don’t socialise as much,” she told the Cyprus Mail. “The way of communication has changed.” If you fancy someone you’re likely to leave a message on their Instagram, not approach them face-to-face.

Ioanna represents one category with experience of antidepressants, being the kind of personality type – she describes herself as anxious, prone to feelings of guilt, worried by loss of control and “naturally a bit negative as a person” – who’s experienced years of mental-health issues, and worked hard to achieve a kind of stability. She was anorexic as a teen, then later suffered from binge-eating disorder and panic attacks.

An even more extreme example is 67-year-old Xenofon Ioannidis who runs Omilos Elpidoforos, a support group for people with chronic mental disabilities. He himself was diagnosed with “recurrent depression with anxiety disorder” and first placed on antidepressants back in 2006, though he’s managed to reduce the dose over the years.

These are people with chronic problems – as opposed to the (much larger) number of patients who are prescribed a short course of meds after a traumatic event like the death of a parent, or just ‘to feel good’ when life gets too much for them.

Is the growing normalisation of antidepressants a problem? Doctors seem confident that the new generation of meds aren’t addictive (with the possible exception of Xanax, says Papetta) and side effects – notably the sexual dysfunction that was such a hallmark of earlier drugs – have been much reduced.

Most importantly, everyone seems to agree that they do help, at least in the majority of cases – about 35 per cent of patients have TRD, or treatment-resistant depression – and at least in calming down that crippling feeling of panic and hopelessness.

That said, “they’re not magic pills,” says Ioanna – who, despite her issues, has sought to make changes to her life (not living alone, spreading out her workload so she doesn’t get stressed out over any one job) rather than rely on medication.

“The pills help at an early stage,” she explains. “When you’re not at all functional, they calm down your system a bit, so you can be more functional and able to solve your problem.”

Trouble is, it’s easy for antidepressants to become a crutch, or an easy fix – and for people to become dependent on that calmness they bring without actually working through their issues. Combining meds with psychotherapy is the obvious solution, but it doesn’t always happen – especially due to the professional divide between psychiatrists (who are medical doctors, and prescribe drugs) and psychologists (who focus on therapy).

Ioanna took fluoxetine for six months in her early 20s; it solved nothing, and only made her drowsy. Later, when her panic attacks began, a doctor put her on paroxetine. That one helped more, and she took it for about two years, working her way down to a small dose before stopping altogether – “and a small dose is good,” she adds in passing, “because it allows you to feel things”.

That’s the other concern, what the drugs do to emotions. “Antidepressants work by repressing a person’s emotional world, so they don’t have flare-ups,” says Xenophon. The danger – if the patient takes them for too long – is that they “become like a vegetable, almost like a zombie”.

The prospect of ending up with a large number of people living in a state of numbed contentment – feeling ‘good’, yet not really feeling much of anything – is a real worry. Ominously, HIO figures show that 64,993 patients (the vast majority) were on meds for over a year during 2019-23. Most courses last a couple of years at least.

‘Almost half of Britons on antidepressants can quit now, study finds’ ran a headline in The Independent on June 26. Long-term use is the big danger here, especially when it acts as a disincentive for people to make more basic changes.

Unsurprisingly, many doctors try to offer alternatives. Orphanides uses virtual reality therapy to help patients manage their anxieties. Nicosia psychiatrist Dr George Mikellides offers repetitive transcranial magnetic stimulation, an FDA-approved treatment using magnetic fields to stimulate nerve cells in the brain.

Papetta takes another approach, asking patients to take a blood test before they begin, checking for what she calls “the magic five”. These five indicators are thyroid, iron, ferritin, hemoglobin and vitamin D – any one of which, if dysfunctional, can affect mood and cause depression as a symptom. Sometimes it’s a simple matter of body chemistry.

Ultimately, the story here is that one in 10 Cypriots suffers from mental-health issues so severe they require medication. Were these people always part of the population, but unable to get help in the past? Or is it rather a case of the mental-health industry creating new mental-health problems (and customers)?

“The apparent increase in mental-health issues may not necessarily mean that more people are developing these conditions now than in the past,” Mikellides told the Cyprus Mail. “It could reflect better awareness, reduced stigma, and improved access to mental-health services…

“However, there is a valid concern about the over-medicalisation of normal life stresses,” he admits, adding: “It’s important to distinguish between clinical conditions and normal emotional responses to life’s challenges”.

Meanwhile, the use of antidepressants keeps rising.