Sad? Here's cause to be glad

Health Check
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OH DEAR. The world is becoming a more miserable place, according to the Government's chief medical officer. Prescriptions for antidepressants - chiefly Prozac and its relatives - leapt 19 per cent among men and 15 per cent among women in just two years from 1994.

Sir Kenneth Calman, who noted the figures in his seventh and final annual report, On the State of the Public Health, 1997, published last week, thinks this is worrying news, a sign of the excessive demands placed on people by modern life.

The rise appeared to indicate a genuine increase in suffering, rather than reckless prescribing and as such "it does merit looking into further", he said.

I beg to disagree. The rise in prescribing is a cause for celebration, not commiseration, a sign that at last misery is being taken seriously as a (frequently) treatable condition. Instead of staring gloomily into the abyss, Sir Kenneth, who retires this week to take up a post as vice- chancellor of the University of Durham, should be breaking open the champagne to mark one of the greater achievements of his reign as the nation's top doctor.

His pronouncement, however, had the predictable effect. Stories headlined, "This pill-popping nation" bemoaned our increasing reliance on pharmaceutical props. Sir Kenneth played up to the agenda - unwittingly, I suspect - that sees the stress of modern life as the source of all our ills.

Yet one of the most serious of our social ills is the unreasonable fear of psychoactive drugs. Depression exacts a huge toll of human suffering, much of it unnecessary because effective treatment is easily available.

It takes the lives of more than 4,000 people a year, many of them young, by suicide. Fear of the stigma of mental illness and professional reluctance to investigate emotional problems conspire to keep the suffering hidden.

Most people have no difficulty with the beta blockers prescribed to millions to control their blood pressure, or the insulin given to diabetics to control their glucose level, but suggest a pill to boost serotonin levels and they react as if confronted by a drug pusher. Surely, goes the standard response, people should be able to cope without such chemical aids.

Or, in the less charitable version, stop moaning and pull their socks up. Well, up to a point.

There are self-help techniques for dealing with depression - cognitive strategies related to positive thinking, for example - as there are for holding blood pressure down - such as exercise. But many people find them impossible to apply or that they do not work. Then drugs should be an option.

Many reject drugs because they fear they will become dependent, but this is based on a misapprehension.

Antidepressants such as Prozac are not addictive, even after many years of use. They are chemically different from the benzodiazepine tranquillisers such as Valium, which are addictive, and which are now only used for short- term treatment of a few weeks.

There is also a deeper, moral, fear, typified by the "pill-popping" headlines. This is the view that doctors who hand out Prozac should be classed with barmen pouring whiskies or dealers selling lines of cocaine. It, too, is based on a misapprehension.

Antidepressants do not provide pleasure, they restore the capacity for pleasure.

Depression drains the pleasure, as well as the point, from life. People in its grip lose the sense of their own value and then of the value of anything. They fear being taken for malingerers and often feel to blame for their condition. The shame adds to the depression. People taking the drugs for the first time are often surprised at how their mood has lifted without their feeling befuddled.

The drugs do not induce euphoria - they restore normal functioning so that sufferers can get on with their lives.

The Royal College of Psychiatrists launched a five-year campaign in 1992 to counter the stigma of depression and encourage more people to seek treatment.

It has now been extended for a further three years under the auspices of the National Depression Campaign, an umbrella group.

The rise in prescribing is testimony to its success. But there is a lot further to go.