The numbers of young Swedes reporting that they suffer from depression, anxiety or other mental health disorders has risen in the last 30 years. That increase has in turn led to a significant rise in prescriptions of antidepressants. In fact, according to the Swedish health authorities, antidepressant prescriptions increased by 36 percent between 2006 and 2012.
Looking at the past, however, the numbers look more dramatic. Between 1991 and 2014, the sales of antidepressants increased by 13,690 percent for girls aged 15 to 19, while the increase for boys was 6,710 percent. But is the rise of prescriptions necessarily an outcome of a deteriorating mental health, or merely a reflection of increased mental health awareness?
According to Sophia Eberhard, Senior Physician at Child and Adolescent Mental Health Services in Skåne, the increase in antidepressants is neither positive or negative. She thinks it's positive that more young people seek care and receive psychiatric treatment when needed. "In Swedish child psychiatry, the patient inflow has increased steadily in recent decades and some increase in drug treatment has occurred. This is largely due to a clearly increased availability and a reduced stigma about seeking mental health care," Eberhard told me.
We know that the developing brain is especially sensitive and that children may suffer more from side effects than adults.
Some critics claim that antidepressants are too easily prescribed in Sweden. Eberhard doesn't think so. She states that this is a simplification of reality. She says that child and adolescent mental health services in Sweden have worked to make it easier for young people to seek mental health care for many years now.
Antidepressants as a treatment option has proven to work best in moderate to severe depression – preferably in combination with psychotherapy. For mild to moderate depression, psychotherapy is recommended, which the mental health service in Sweden offers, too. A small number of patients, however, decline psychotherapy as a treatment and want to be treated pharmaceutically right away. The psychiatric caregiver can consider this, as long as the patient, the family and the caregivers agree.
As with any other medication, antidepressants have side effects, especially for young people whose brains are developing. This is a fact that child and adolescent psychiatry are aware of, which is why they monitor side effects closely when prescribing antidepressants to young people.
"We know that the developing brain is especially sensitive and that children may suffer more from side effects than adults," Eberhard said. "This has to be balanced against the need of treatment, where one must take into account that untreated severe depression is a potentially fatal disease. It is ultimately an individual assessment, where the child's psychiatric caregiver listens to the patient's and the parents' treatment preferences, and on the basis of evidence from clinical trials as well as clinical practice, chooses the most suitable treatment."
Anna Norelius is an engineering student who founded the initiative INSIKT when she received her ADHD-diagnosis, one year ago. The aim of the project is to break taboos of talking about mental health issues. Norelius felt that the pressure of fitting into society was too much of a burden, one that eventually led into a depression.
"I wasn't offered antidepressants until later in my treatment. It often felt like mental health services didn't take me seriously enough," Norelius told me. "I didn't feel like psychotherapy would help me, and I would do anything to get out of the situation I was in. When I was offered antidepressants, I accepted immediately."
I realised that I always had an excessive self-focus and cared too much about what other people thought of me. Antidepressants helped me see past this – and to be able to change my life for the better.
Norelius is positive that without the medication she might not have survived her mental illness. "At the beginning when I took antidepressants, my anxiety increased and it felt like it would kill me. If I hadn't been involuntarily committed to a psychiatric facility, I'm not sure I would be alive today. After two weeks on antidepressants, the anxiety started to disappear and I felt like I came back to life. I realised that I always had an excessive self-focus and cared too much about what other people thought of me. Antidepressants helped me see past this and change my life for the better."
However, antidepressants do not always bring on a positive change. Many people experience an increase in anxiety and depression after taking the medication, and choose not to continue with the course even if they are advised to do so.
"Rebecca" began taking antidepressants at the age of 13. She claims the medication made her emotionally numb, removing her true self and preventing her from helping herself. She feels like mental health services neglected her cries for help and only prescribed medicine as a temporary solution. It all came to a point, when she actually considered taking her own life and the medication made those feelings even worse. After several years of treatment, she decided to quit. It was then that she was able to focus on finding the core to her depression – and a lasting solution to her mental illness.
"The side effects of antidepressants are relatively small, but the problem is that some people do not make the changes in their lifestyle that are necessary to get out of a depression, and choose to rely on the medicine instead," says psychiatrist Martin Kennerland at Department of Psychiatry at NU-healthcare.
According to sociologist Ylva Almquist at Stockholm University, it's hard to say whether Sweden's youth are unhappier today than in the past – even if statistics show signs of that. Almquist thinks that mental illness and antidepressants have been normalised in the last few years, which might be one reason behind the increase.
There is no single reason to why young Swedes take more antidepressants than ever before. It's easier to receive help for mental issues today. Also, efforts to eliminate the taboo of mental health issues are done by both private persons, such as Norelius, and by the mental health care, with professionals such as Eberhard in the forefront. This, in combination with a more developed medical field within antidepressants, could be the answer to the rise.
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