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Why has prescribing of antidepressants increased over the last 30 years?

In a recent post on the platform X, Elon Musk claimed that antidepressants were over-prescribed. In many countries, the prescribing of antidepressants has increased significantly over the past 30 years. During the 1990s, public health campaigns aimed at reducing the stigma surrounding depression encouraged more people to seek treatment. This contributed to a rise in antidepressant prescriptions in countries such as the UK. 

Additionally, antidepressants - particularly selective serotonin reuptake inhibitors (SSRIs) - are now widely used not only for depression but also for other conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and chronic pain. This expanded range of indications has been a significant factor in their increased use in recent decades.

One concern regarding antidepressant use is their potential toxicity and their role in suicide. SSRIs are generally considered safer than older antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are more likely to be associated with fatal overdoses.  

Because of their better safety profile, doctors are more willing to prescribe SSRIs than the older antidepressants. Their relative safety has made SSRIs the preferred choice of drug for many doctors and is also a factor in the increased prescribing of antidepressants.

Antidepressants do play an essential role in managing depression and some other mental health conditions, but over-prescription may occur in some cases due to system-wide barriers like limited access to psychological therapies. Addressing the wider determinants of health is also important. This would include areas such as poverty, housing and access to green spaces and other leisure facilities.

The increase in antidepressant prescribing in the UK has sparked debate about whether they are being over-prescribed. However, antidepressants are a clinically effective option for moderate to severe depression and are now used for a broader range of conditions, such as anxiety disorders and chronic pain. Ensuring a balanced approach, where pharmacological and non-pharmacological treatments are accessible and appropriately used, remains a key goal for improving mental health care in the UK and elsewhere in the world.

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