Are we a nation of junkies and depressives

At first glance it would seem that we are a nation of junkies and depressives. In a survey of 7,000 people aged 15-64, 10 per cent have used antidepressants in their lifetimes; while 11 per cent have used tranquillisers/ sedatives. Of greater concern, 11 per cent of the latter obtained them without prescription; 7 per cent from people they knew; and 2 per cent from pharmacists!

If we tease out the data further, 6 per cent of women and 4 per cent of men had used antidepressants/sedatives in the previous year. Women over 35 with long-term State dependency and lower educational levels were most at risk. A particular concern was the abuse of Benzodiazepams, particularly in opiate addicts.

In analysing this data, the first crucial step is to clearly distinguish sedatives and tranquillisers from antidepressants. The first group are primarily used to relieve the symptoms of anxiety and since the 70s have been a problem in terms of both addiction and abuse.

The second group are used to treat depression, bipolar disorder, eating disorders and OCD. The key difference between both is that the former are definitely addictive, ie cause “craving” when withdrawn, while nobody ever “craves” antidepressants. This vital distinction is often missed.

Let’s first examine the usage of antidepressants. I have always been in favour of the holistic approach to depression -a combination of lifestyle changes, drug therapy and talk therapies - with each person deciding the road they wish to travel.

Is the annual rate of usage of these drugs excessive as outlined in this survey? If we accept that 10 per cent of women and 5 per cent of men will be experiencing a bout of depression at any one time and that 300-400,000 people in Ireland are affected by this illness, and also add in the significant numbers with bipolar disorder and OCD, then figures of 6 and 4 per cent respectively seem proportionate.

Women are twice as likely to develop depression and since stress is the major trigger for this illness, it is no surprise that women in disadvantaged social situations are most at risk. Lack of self-esteem, poor nutrition, financial, educational and relationship difficulties, often in lone parent situations, combine to create a vulnerability to depression.

When we add in a lack of counselling and other mental health services like CBT to such groups (who can’t “buy” these services), then drug therapy may be all that is available. The use of tranquillisers is, in contrast, a much greater issue of concern. GPs all inherited a generation of tranquilliser addicts from the inappropriate use of these drugs in the 70s and 80s.

While effective at “numbing” the symptoms of anxiety, it took time to realise their longer term addictive potential. This legacy unfortunately extended to their usage in acute anxiety states like panic attacks/ phobias, and more chronic anxiety - all common in women. Drug addicts also quickly recognised their “appeal” and a “street culture” of “tranquillizer trading” emerged. Alcoholics have also learned to use them to handle withdrawal symptoms until their next binge.

Those addicted to tranquillisers are adept at lying, denial, manipulation, forging scripts, stealing them from friends and family, and moving from doctor to doctor and pharmacy to pharmacy to feed their habit. Many, particularly women, start with anxiety and finish up with addiction, which becomes the major problem.

Appropriate provision of services to treat anxiety and addiction disorders, along with social supports to groups like the women identified above, must lie at the heart of dealing with this problem. We pay lip service to both. The document, Vision for Change, gathers dust as we continue (as with suicide) to define the problem but do little else.

Most GPs and pharmacists are aware of and unhappy about misuse of tranquillisers and would welcome assistance to deal with the issue. The solution, like the problem, will have to multi-faceted.

While this survey will gain a lot of attention, I am more concerned about the widespread usage of alcohol in our community; the use of wine in women in the 30-50 bracket, to cope with stress and anxiety; and with the hidden problem of significant hash use in our young people. We better be careful as a nation not to worry about potholes in the road while overlooking the truck hurtling in our direction!

Dr Harry Barry is author of Flagging the Problem: A new approach to Mental Health (Liberties Press) and a director of Aware.

Source: Dr Harry Barry, The Irish Times, 31/03/2009