Why so many antidepressants are taken

According to recent research, the Dutch are among the happiest residents of any country in the world. But, at the same time, the use of antidepressants doubled between 1999 and 2006. There are now more than a million antidepressant users in the Netherlands. It is striking that in England Prozac, one of the best-known antidepressants, is apparently taken so often that traces of it have been found in the groundwater. How is it possible that so many antidepressants are taken?

Much discussed and much described

According to the World Health Organization (WHO), the number of depressed people in the United States is 16%, in Western Europe 5-10%. This phenomenon is discussed in several recent publications. Trudy Dehue, professor in Groningen, wrote a book about The Depression Epidemic. A professor from Amsterdam, Willem van der Does, expressed a completely different opinion. They agree that the diagnosis of depression has not increased at all, it is stable at 5% per year. The suicide rate has been declining since 1983. But the use of antidepressants is epidemic. Every year 800,000 new prescriptions are written for these pills, it seems that what is classified as depression is expanding enormously.

Why are so many antidepressants taken?

There are four possible explanations.

  1. Improved diagnostics mean that depression can now be better diagnosed and treated, which has resulted in an increase in antidepressant use.
  2. The pharmaceutical industry has talked people into developing the disorder for profit, thus creating a demand for medication.
  3. The welfare state has made people small-minded, causing them to need antidepressants more quickly.
  4. There has been a cultural change in thinking, which means that much more is demanded of people, and they are more likely to turn to antidepressants again.


Explanation 1: Increase in antidepressant use due to improved diagnostics

The standard explanation is that depression itself has not increased, but the possibilities in which it can be diagnosed and treated in affluent countries have increased. In the past, a lot of depression was undertreated, but now we treat it with antidepressants. Depression would then be a biologically determined disease that has existed for centuries, but is now better recognized.
There are two things wrong with this explanation: 1) depression as we know it has not always existed and 2) depression is not by definition a biologically determined brain disease.

  1. It is a misunderstanding that depression as a disease, as we know it today, has always existed. ‘Depression’ as a concept cannot be stripped from the context in which we know it. Depression concerns the symptoms (including sadness, inability to enjoy life, sleep, concentration and eating problems) that we name as a cluster. The DSM classification does this, it clusters a number of symptoms and gives them a name. But the fact that it is a disease is due to the meaning attached to the symptoms. Symptoms have always existed, but their meaning was and is very different in different times and cultures. Until recently, depressive symptoms did not exist as a disease in Japan. On the contrary, sadness and resignation were positive characteristics of wisdom, moral sensitivity and spirituality. Defining something as a disease is a social choice.
  2. Evidence of neurobiological changes has been observed in depression. For example, damage caused to the brain by stress and adversity (changes that are also partly found in ‘normal sadness’). Finding medication that seemed to be the solution for depressive complaints contributed to the image that it was a disease with a biological cause. But the existence of these neurobiological changes does not necessarily mean that it is a brain disease. Suppose, even if an undisputed biological basis for depression is ever found, it does not automatically follow that it is a disease. Just as this does not apply to homosexuality or red hair.

We only speak of a disease when we find the symptoms unacceptable and turn to medicine for a solution. The fact that depression is a disease is therefore a social decision. Assigning the disease label also means that it is a case for the doctor; medicine is used for the solution.

Explanation 2: Increase in antidepressant use caused by the pharmaceutical industry.

According to this statement, the use of antidepressants has increased because the pharmaceutical industry has created a demand for profit. She would then have talked people into developing a disorder, or at least made a drug necessary.
The pharmaceutical industry has indeed invested a lot in marketing and imaging. Everything has been done to create the idea that there is an ultimate happiness substance. Grateful use was made of the alleged biological basis for depressive complaints. (see image). If Romeo and Juliet had taken antidepressants, they would not have committed suicide, but would have been happily married, the pharmaceutical companies seem to be saying.
However, this explanation is not sufficient for the enormous increase in antidepressant use. People fight their depression with much more than just medication. Self-help books and courses are used, and prevention campaigns from the government are also widely deployed.

Explanation 3: Increase in antidepressant use because the welfare state has made people small.

This statement is mainly expressed by conservative thinkers (Furedi, Dalrymple). According to them, Mental Health Care (GGZ) makes people believe that they are weak and pathetic and that they are dependent on mental health care. People would thus take on a victim role and pass on responsibilities.
Psychiatrist and publicist Dalrymple notices that the active word unhappy has disappeared from the idiom and has been replaced by the passive depressive. “Being unhappy is a reason to change your life yourself, to improve it. But depression is a disease, you can’t do anything about it, it is the doctor’s responsibility to cure it. If you think like that, Dalrymple argues, then you want personal happiness and mood to be independent of the way of life. No connection is made between state of mind and the way one lives.
This statement points in the direction of social behavior and ideals. Yet this statement cannot be sufficient, After all, the depression epidemic emerged precisely with the breakdown of the welfare state.

Explanation 4: Increase in antidepressant use due to a cultural shift.

Trudy Dehue argues that antidepressants are being used much more often because people are increasingly demanding more of themselves. Depression is then the flip side of the pressure experienced to realize oneself. This self-realization is about becoming and remaining a person who is strong, motivated, purposeful, enterprising, flexible and has good communication skills. This self-realization is the ideal and virtue in today’s society.
In the current living environment of the neoliberal market society, people see themselves as a business that needs to be worked on. Striving for the ideal and competition are prominent. Not being able to participate in working to meet the ideal is considered to be at least experienced as a problem. You realize yourself, you are responsible. People are becoming increasingly responsible for failing to live up to the ideal. This creates increasing pressure on the postmodern individual; it is no longer allowed but must. The former soft right to autonomy has degenerated into a hard obligation to be autonomous. If everyone is personally fully responsible for his own fate, unhappiness becomes more and more a personal shortcoming in the strong firm duty to self-realization.
Added to this is the biological view of depression . Attention is diverted from the circumstances as the cause, and causes us to think not only in terms of our own responsibility for recovery, but also in terms of self-improvement. Where the cause of depression is localized in biology, this mandatory self-care quickly implies the use of medication.
In short, people who (have to) work on inner improvement can no longer rely on circumstances due to the biological view of depression. The obligation to self-realize leads to feeling obliged to use medication.
Both patient and doctor (unconsciously) go along with this. One expects from oneself or from the patient the will and need for self-improvement, following from the self-realization ideal. Combined with medication self-care following the biological view of depression, the prescription and use of antidepressants is increasing.


The increased use of antidepressants is explained by several interlocking factors. Pharmaceutical interests and social thinking are the most important here. The DSM is a construct of Western people, viewing depressive complaints as a disease is a social decision.
The following can be learned from this in current medical practice . The doctor is an easy point of contact in case of misery and suffering. While misery used to be alleviated by family, social work, pastor or preacher, nowadays it falls on the doctor, who often labels these complaints as a disease and offers medication as a solution. The doctor should be careful not to see more and more forms of suffering as appropriate in the context of depression, i.e. as a disease that must be remedied by the doctor or psychologist. Medicalization must be prevented where possible.
It is instructive to consider what the personal opinion is about the feasibility of the individual and what the ideals and standards are. Suffering and shortcomings do not always have to be solved, there must also be room to accept them and integrate them into everyday life.

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