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April 09, 2014
Are Canadians really that depressed?

Too many doctors are prescribing anti-depressants to treat “normal” periods of sadness, says one of Canada’s leading psychiatrists.

According to McGill University professor and former chair of its Department of Psychiatry, Dr. Joel Paris, too many Canadians are treating unhappiness in the same way they would handle something they dislike about their bodies:  by asking their doctor to fix the problem and make their lives better.

“We’re not always happy and there are often good reasons for unhappiness but there is this idea that we should all have high self-esteem, fantastic relationships and tremendous jobs,” Dr. Paris asserts.  “It’s like cosmetic psychopharmacology:  If you don’t like the way you look, you go to a plastic surgeon.  If you’re not happy enough, you go to a doctor and go on anti-depressants.”

Canadians have the third highest consumption rate of anti-depressants among the members of the Organization of Economic Co-operation and Development (OECD), easily exceeding the rates of other developed countries such as Italy, France and the United Kingdom.

According to the OECD’s 2013 Health at a glance report, 86 out of every 1,000 people in Canada use anti-depressants on a daily basis.  With usage rates of 106 and 89 per thousand respectively, only Iceland and Australia exceed that rate.  Usage rates in comparable countries such as Italy, Germany and the Netherlands range from 42 to 50 per thousand.

More than 42 million prescriptions for anti-depressants, valued at more than $1.8 billion, were filled by Canadian pharmacies in 2012.

Such medications should only be used for severe, debilitating or life-threatening depression, Dr. Paris says.  In addition, in cases of mild depression, the effectiveness of anti-depressant medications is often negligible or, at best, they produce a placebo effect, which may not last.

“Then you get onto this thing where you try one then another…It’s a whole treadmill of pharmacology that people get caught up in,” he says.  “They’re terrified to stop.  The fear of relapse has driven doctors to keep people on them for years.”

Compounding the problem is a lack of training among family physicians, who account for the bulk of prescriptions for the drugs.  As well, diagnostic criteria for depression are often too vague or flexible, the McGill professor says.  For example, the criteria for a major depressive disorder involve two weeks of being in a depressed mood for most of the day.   Common occurrences, such as a loss of a job, a relationship break-up, grief or other normal disruptions in daily life can create those symptoms.

“Half the population will meet the criteria at some point in their life,” Dr. Paris says.  “It’s almost like the common cold.”

In 2012, the OECD reported that depression is becoming a leading cause of death, disability and economic dislocation and predicted that, by 2020, it will be the second leading cause of illness in the world.

An employee assistance program (EAP) can provide referral or other professional services to help plan members and/or their family members to cope with depression.  Contact your Coughlin consultant for more information.

Anti-depressant use among children skyrockets

The number of children being prescribed anti-depressants has jumped by more than 300 per cent over the past 24 years, according to a study conducted by the University of Saskatchewan and Ottawa’s Montfort Hospital.  

According to reports published in the February 20, 2014 edition of the Ottawa Citizen, the rates of anti-depressant use among children and teenagers age 19 and under is soaring.  The heaviest users:  girls age 15 to 19.  According to study findings, the number of prescriptions written for that demographic group multiplied by 14.5 times from 1983 to 2007.

Of particular concern is the increased prescribing of selective serotonin reuptake inhibitors (SSRIs), powerful medications that Health Canada has warned could result in side effects such as mania, aggression, suicidal behaviour and other abnormal behavioural changes.

While these drugs are often given to adolescents and children, none of them have been approved for use among that group.

The daily usage rates of anti-depressants among young people average 15.4 per thousand, the
study says.  The Canadian average is 86 per thousand (see chart below.)   In 1983, the usage rate among 10-to-19-year-olds was 5.9 per thousand, the University of Saskatchewan study notes.

While the study’s data is confined to the province of Saskatchewan, “We would not be surprised if other provinces experienced similar trends,” says study author and University of Saskatchewan research associate Dr. Xiangfei Meng.

The sharp increase in anti-depressant use among children and teenagers raises an important clinical and moral question:  are psychiatric illnesses among young people being diagnosed more frequently or are doctors over-prescribing anti-depressants to members of that group?  

Either way, plan sponsors and administrators should expect to see increased claims for anti-depressant medications among children and teenagers.

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