Over-prescribed and over-used

September 11, 2022

Clinicians should practice caution against excessive and unjustifiable use of antidepressants

Over-prescribed and over-used


he past decade has seen a significant rise in mental health awareness and its acceptance worldwide: a welcome change from the denial and stigmatisation prevalent during the ’90s and early 2000. With frequent debates around the subject, medical jargon has trickled into our vocabulary, blurring the lines between medical diagnosis and informal speech. One such example is using depression as a synonym for stress, or its more intense form, distress. While it may seem harmless, this interchangeable use may confuse our understanding of the terminology.

Stress is a normal response to our day-to-day challenges, whereas depression is a clinical entity. In a healthy amount, stress motivates us to overcome obstacles and achieve goals. Instead, depression results from an overwhelming of the coping mechanisms of the brain. It is a clinical diagnosis based on a set of pre-defined criteria.

Confusing distress with depression is not limited to people outside healthcare. Unfortunately, many physicians seem to share the same misunderstanding of the two terms.

A questionnaire designed specifically for this purpose has offered some clarity, but its use is uncommon in our clinical setup. Although the physicians in our healthcare system mostly work like general practitioners of the Western healthcare model, their training mandate does not involve psychiatric exposure. As a result, they sometimes lack the clinical acumen to deal with mental health issues. Regardless, since they encounter patients more frequently and at the earliest stage of their health care journey, they often diagnose distress as depression, leading to an over-prescription of anti-depressants.

Depression is a challenging subject, as is any mental health issue. Even with the recent advances in psychiatry, we have yet to make any significant breakthrough in restoring mental health and bringing some sense of normalcy to the patients’ lives. Socioeconomic and cultural factors are chiefly responsible for considerable distress, particularly in vulnerable groups. Practically, the nature of these causes makes it taxing to deal with depression, especially in a time- and resource-limited system. For these reasons, physicians see anti-depressants as the only solution.

When used for the selective patients that may benefit from them, anti-depressants can save lives. However, clinicians should practice caution against their excessive and unjustifiable use. The trend among physicians and psychiatrists in the region seems anything but judicious.

Given the dangers of over-prescription, anti-depressant use should be curtailed, both by clinicians and patients.

One situation that stands out is the use of antidepressants in adolescents. Almost every adult is familiar with the testing nature of puberty for the child and their family; more so for females, for self-evident reasons. Therefore, their mood swings, obvious distress, and rebellious attitudes should not surprise us. These behaviours reflect the average response of a child to their changing physiology and anatomy. Adolescence includes not only a physical growth spurt but also emotional and psychological development. As they say, stress is a catalyst for growth; this may be one of the few examples where we see tangible results.

With the ongoing developmental process of sexual and personal identity formation alongside logical, moral, and abstract thinking evolving, it seems counterintuitive to use drugs that cause emotional blunting. Allowing a child to go through the stress associated with puberty promotes normal maturation and healthier neural connections. Anti-depressants may numb the mind’s response to stress and lead to maladaptive responses during their crucial formative years. Inevitably, this will have long-term implications in dealing with future life challenges. That is not to advocate against professional help or anti-depressants when needed; yet, the threshold for their use shouldn’t be as low as is currently in practice.

With the apparent limitations of a resource-starved country, expecting professional help beyond drugs could be a stretch for most; unfortunately, there are no definitive solutions to the problem. The latest research emphasises social support as being central to restoring mental health. It plays a role in protecting children from becoming overwhelmed by stress. Although, for social support to make any significant difference, it is critical for those in distress to feel seen and heard- a characteristic lacking in our traditional ways of bonding. This feeling of safety in their social circles allows the hyperactive neural mechanisms responsible for depression to calm down and promote healing. It also helps to work on strengthening coping mechanisms.

Before considering the use of anti-depressants in children, therapists can teach these coping strategies in their clinics. Current guidelines also recommend anti-depressants as a second-line treatment option for depression in children. Given the dangers of over-prescription, anti-depressant use should be curtailed, both by clinicians and patients. Besides, rushing to the doctor’s clinic for every little stressful episode may not be a good idea. Accepting stress and grief as a part of our lives, and viewing them as necessary stimulants for our emotional growth, may equip us with better coping mechanisms. In most instances, time and space to process our feelings with the support of our loved ones are enough to deal with them.

The writer is a doctor with a particular interest in mental health. She can be reached at tahiraabrar@gmail.co

Over-prescribed and over-used