According to Paul W. Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behavior at McMaster University in Ontario, Canada:

Antidepressant medication is the most commonly prescribed treatment for people with depression. They are also commonly prescribed for other conditions, including bipolar depression, post-traumatic stress disorder, obsessive-compulsive disorder, chronic pain syndromes, substance abuse and anxiety and eating disorders. According to a 2011 report released by the US Centers for Disease Control and Prevention, about one out of every ten people (11%) over the age of 12 in the US is on antidepressant medications (italics added). Between 2005 and 2008, antidepressants were the third most common type of prescription drug taken by people of all ages. They were the most frequently used medication by people between the ages of 18 and 44. In other words, millions of people are prescribed antidepressants and are affected by them each year.

This information is in keeping with most of the statistics I have read, which show that the percentage of adults using antidepressants in developed countries is extraordinary. It is alarmingly high to most everyone – except for the companies that manufacture and profit from them. In short, this is a major alert. We need to re-think the rampant use of these drugs.

The narrative used to support this widespread use is simple: Suicide is the result of depression and depression is a disorder amenable to drug treatment. It is a simple but quite muddy thinking that is pushed out to both the medical and general population. It comes from misinformation coupled with aggressive advertising by drug companies to the public as well as professionals. They advertise directly to the public, and promote it through continuing medical education events for professionals. All of this is paid for and promoted by the very companies profiting from the sales. They tell the public to rely on the doctors, and they tell the doctors to rely on the pharmaceutical company sponsored literature along with other information that is not subject to outside or peer review.

Here are a few points to consider:

[1] Suicide attempts do not necessarily result solely from depression.

For some time, it has been noted as a potential side effect that some antidepressants actually lead consumers to suicidal behavior. The term “suicidality” has been brought into somewhat common use. The U.S. Food and Drug Administration (FDA) proposed that makers of all antidepressant medications update the existing black box warning on their products’ labeling to include warnings about increased risks of suicidality, suicidal thinking and behavior, in young adults ages 18 to 24 during the initial treatment. Initial treatment generally refers to the first one to two months of medication usage. The first question I have with this warning is whether the label is primarily for prospective litigation defense rather than for any other patient centered reason.

Suicide is a complex behavior that cannot be reduced to a pseudo-scientific term like suidicality. Not all depression leads to suicidal ideation. I believe suicidal behavior is a form of anger turned inwards. I have numerous examples of patients who harbored internalized rage. By turning and maintaining that intense anger inwards, the need to express that rage was translated into suicidal behavior.

Once, a suicidal patient was referred to me who was taking an overdose of drugs every other day. She would end up in the Hospital Emergency ward for weeks on end. Finally, some of the nurses in the ER suggested sending her to me because what her then-therapists were trying was obviously not working.

I saw her a few times. She told me that she was extremely angry at one of my colleagues, a psychiatrist who had a responsible position in the hospital. She was boiling in anger but had no way to complain about his conduct. Just listening to her and acknowledging her grievances was ventilated that smoldering anger.

The ritual of repeated hospital visits was her way of expressing her anger. The simple act of listening and acknowledging her with empathy abruptly ended her repeated “suicidal overdoses.” Someone with a psychiatry degree, me, bothered to listen to her. Listening and acknowledging her was all that was needed to change her behavior. She stopped coming to see me after a few sessions, and abruptly ended her pattern of overdoses and visits to the ER.

I was later asked what I had done to stop her suicidal behavior. I hadn’t done much other than recognizing that her suicidal behavior was simply her way of protest. It was how she was trying to tell the world how angry she felt being trapped in that authority/helpless victim struggle with a perceived authoritarian psychiatrist with degrees and status. She was a single woman in her 50s feeling powerless. I was confident about the importance of listening and acknowledging her because 2 other patients had already complained to me about that psychiatrist’s abrasive manner in their own encounters with him.

This was an example of a patient who perceived that their therapist was not interested in listening to her innermost concerns. Immediately, such a patient loses his/her faith in the therapeutic relationship. If the doctor’s primary goal is choosing a pill as the mainstay of treatment, that is a direct message to the patient. That direct message is not one of empathy or compassion. The patient may and will likely feel rejected, ignored, helpless, and hopeless. Anger should be an expected response. And anger will often be redirected inward or outward.

If the patient loses hope, suicide is often seen both as a way out and a statement of protest. It is a red herring to coin a new word “suicidality”, as if that is a reasonable scientific risk of chemical side effects. It is as deceptive as implying that depressed patients will most likely have their depression alleviated with magic chemicals labeled “antidepressant” and that there is a mix of chemicals/dosages that will make the problem disappear.

[2] Antidepressant use is not an accurate reflection of the prevalence of depression.

The popularity of antidepressants in a given country is the result of a complicated mix of depression rates, stigma, wealth, health coverage, the degree of aggressive sales tactics of the pharmaceutical industry, the availability of treatment. It is also tied to the biological bias of the therapists toward chemical intervention rather than psychotherapy – most of whom are trained and marketed to by the pharmaceutical sales representatives.

Again, I want to be completely clear that I am not aganist the appropriate use of antidepressants as an adjunct to psychotherapy. I have done exactly that with some of my patients. However, the mind is not simply a box of neural circuitry where wires can cross and be uncrossed, where chemical switches can simply be toggled on or off. We must not forget our humanity. Do not ignore its powerful effect in helping to transcend despair. We must not forget the power of empathy, of compassion, and of hope in healing and recovery.