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Winona Ryder as Kaysen in ‘Girl, Interrupted’, a cultural touchstone for the romanticisation of mental illness

We’re using more drugs than ever to treat teen mental health

The age that people go on medication is getting younger – we talk to kids and experts about their experiences

“Sylvia Plath with the ego of Madonna” was the description on the back of Elizabeth Wurtzel’s memoir, Prozac Nation, when I bought it and read it as a teenager in the mid-noughties. It had originally come out in ‘94, one year after Susanna Kaysen’s book Girl, Interrupted, with both going on to become cult films. Christina Ricci played Wurtzel, who struggled with depression as a freshman at Harvard, and Winona Ryder starred as Kaysen, an aspiring author admitted to a psychiatric unit in 60s America. For my generation, they were cultural touchstones for the romanticisation of mental illness. They were to prescription drugs what Trainspotting and Human Traffic were to the class A type – not positive portrayals, but they made depression seem more like an identity than an affliction.

Skip forward 20 years, and Wurtzel’s story is no longer extraordinary; when I re-read it the other day, I thought about how many people the book’s subhead, “young and depressed in America”, applies to. Statistics suggest that 1 in 6 Americans take anti-depressants or other types of psychiatric drugs, and the trend has now been exported to Britain too. In the UK, the number of people on anti-depressants or anti-anxiety medication has doubled in a decade, and perhaps most worryingly, like our American cousins, the age that we go on these drugs seems to be getting younger and younger. A recent UK study found that the number of antidepressants given to kids under 18 has risen 30 per cent in just 10 years.

Young people in Britain are facing a mental health crisis, and doctors are quick to medicate. Sarah*, a teenager from North London, says she has experienced bursts of depression on and off since she was 13 years old. She tried therapy, switching her contraceptive pill and exercising more, but nothing would shift the feeling; “I didn’t find enjoyment in anything, I didn’t really want to be alive.” Sarah was nervous about taking medication in case it would “numb her sense of self”, and because her parents, aside from being worried, kept saying how their generation “just got on with things”. But after dropping out of art school at 18, and losing several jobs because she was so depressed, Sarah went to her GP and asked for a prescription.

“I was crying and he said do you want to see psychiatrist and I said no... he just wrote me a prescription there and then for a drug called Sertraline, which I now take every day in 50mg tablets,” she remembers. An SSRI, which ups your serotonin levels, positively affecting your mood, Sarah said the drug helped: “I feel much more comfortable now I’m on it. At first I had the usual side effects like insomnia, or feeling high for a few hours a day. But after two months it evened out and now I feel like socialising for the first time in ages. I get out of bed and actually manage to do several things in a day.”

 

“I was crying and he said do you want to see psychiatrist and I said no... he just wrote me a prescription there and then for a drug called Sertraline” – Sarah

As a teenager in the South of England, and later in the same part of London as Sarah, I hardly knew anyone my age on anti-depressants 10 years ago – or at least, if I did, they didn’t talk about it. Now, I could name 25 friends taking mental health medication daily, including myself. Sarah agrees; she says her friends are open about discussing mental health issues – and almost everyone she knows seems to have had one, with many on pills for it. “I must know at least ten people who are on anti-depressants or anti-anxiety drugs,” she says, “and the thing is, they all say it’s making life more livable.”

Robert Whitaker is an author and journalist who has written three books on mental health in America. He describes the situation with prescription drugs in both countries as “out of control”, explaining that, if it feels like there was more alarm around America’s prescription drug epidemic in the past, it’s not because statistics have gone down, but because “it’s just not news any more”, specifically not in Europe, where the culture has become similar to that in the US.

When asked if that’s because our collective mental health getting worse, or because we’re just turning to medication faster, Robert says it’s very difficult questions to answer, because part of it is likely down to social change, yes – like the pressures put on young people by social media, or the financial climate – but there are other issues at play.

“Rich kids often want a prescription for ADHD either for more time on tests or so they can resell them as stimulants,” he says. “But with poor children on Medicate it’s more complicated, sometimes drugs are forced on them, because kids are seen as misbehaving in school – especially kids in foster care, those are medicated at the highest rate of any group, particularly with more powerful drugs like antipsychotics.” And then, behind the scenes, he says, there is larger, more commercial, story to blame.

“That story began in [50s and 60s] America,” explains Whitaker, “when the American Psychological Association (APA) started to distinguish undesirable behaviours like being unhappy or anxious or rebellious as abnormal.” Spotting an opportunity, pharmaceutical companies would effectively pay psychiatrists to join the APA and write the book on what constituted a mental health problem, which then opened up the possibility of a drug getting approved to fix the disease. The book was called the DSMIII – aka the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders – and it formed the basis of what psychiatrists would use to diagnose people. “The APA managed to control a lot of journals so that if you wanted articles published you needed to use the DSMIII for categories. That ensured it became the lingo of the day, and helped market the thinking to Scandinavia and Britain, for example,” Whitaker explains.

As pharma companies and psychiatrists began to sell the story of depression, anxiety and ADHD, regular people started seeing themselves within these narrative frameworks, says Whitaker. “People thought, ‘I’m not supposed to be having these thoughts or emotions’, and that leads to a situation where we think of ourselves as having psychiatric problems instead of normal difficulties.” The result, he says, is that “kids [today] aren’t as resilient” as the generations that went before them. He gives the example of the high number of kids that access mental health services in America’s liberal arts colleges, which he suggests is around half of their students. “That didn’t used to happen,” reflects the author. “So: do more people have depression or anxiety, or are they just seeing themselves in different way? It’s a little bit of both, I think.”

James* is 12 years old, from Leicestershire and has been taking Fluoxetine – that’s the drug better known as Prozac – for four months. When I talk to him over the phone about his experience with the anti-depressants, he explains that he was suffering debilitating panic attacks and depression at school, something that was exacerbated by being in a huge building full of strangers; “I’d sit with my knees tucked up to my chest, rocking, and I couldn’t breath properly.”

James tried therapy, but it “wasn’t doing much”, so he was referred to CAMHS (Child and Adolescent Mental Health Services), where after a few assessments he was recommended therapy again, alongside a low dose of medicine. He says his parents left the decision up to him, but that because one of them were on similar medication, and he’d seen the positive changes, he knew it could help a lot. I ask if he ever worried whether he was too young. “I felt like: ‘is this a decision I want to make later in my life?’ but because I was having severe suicidal thoughts I also felt like ‘if I don’t do something about it and try to improve my mental health I might not actually be able to do it in future – it might be too late’.”

“I don’t think you can argue that lots more people just think they’re experiencing depression or anxiety, ‘cause so much of that is physical” – Sarah

After I speak to James, I chat to his mum, who tells me the drugs are helping him a lot and that he might be able to go back to school soon after significant time off. She also puts me in touch about Jess, a neighbour who is 17 and has been taking similar drugs for around a year. Like Sarah, Jess takes Sertraline – 50mg daily – and considered medication a “last resort”. Jess explains that she didn’t want to go through CAMHS because she heard that they were overloaded and it would take too long at a time when she was swiftly coming up to exams and was worried about her ability to cope. She was given the Sertraline prescription over a phone consultation with her GP.

Talking to James, Jess and Sarah, there are some points they all agree on – one is that it’s hard to pinpoint a reason or a cause for the way they’ve been feeling. Sure, a relationship with a family member or the fear of starting a new school might exacerbate things, but if there were a cause to their problems, it’d feel easier to fix. They also all agreed that there’s probably more awareness around these issues today, making it easier for young people to understand mental health issues as a disorder. “I don’t think you can argue that lots more people just think they’re experiencing depression or anxiety, “cause so much of that is physical,” says Sarah. “When I was depressed I felt like I couldn’t do anything, not even cry – but also maybe the statistics are higher because more people are bothering to get a diagnosis now, whereas before, they didn’t go to the doctor.”

Marc Bush is the Chief Policy Adviser at the mental health charity YoungMinds, and suggests that GPs are playing a large part not only in the UK’s high number of diagnoses for mental health problems, but also the high number of people on prescription medication. In a time when government NHS cuts have left mental health services stretched and underfunded, doctors could be quicker than ever before to prescribe drugs as a “short-term solution”, suggests Bush. He expresses a concern that long waiting-times and high thresholds for treatment mean UK GPs feel under pressure to prescribe antidepressants to children, despite considerable risks. 

The biggest problem with the number of kids put on prescription drugs in America, as widely reported in the press, is that once they go on them, they often stay on them well into adulthood and sometimes for life. Research shows that, in the US, less than a third of the people who take an antidepressant have actually seen a mental health professional within the past year. The same can happen here, but more than that, Marc Bush at YoungMinds worries that we’re not always making informed decisions about whether these drugs are the right approach to begin with. There is a lack of misinformation around side effects, and of the potential of building up a tolerance, he explains. YoungMinds conducted a survey which found that half of young people taking mental health medication were unhappy with the information they’d received about them.

When I ask 12-year-old James what the side effects of his drug are, he’s quick to answer; “things like a possibility of increased depression, drowsiness, sleep cycle – that’s affected me – suicidal thoughts.” His knowledge about these medications is almost impressive, as is Jess’, who said she did her own research online (NHS Choices, not forums), as well as grilling her doctor to explain everything scientifically. But both kids say they felt like they knew a lot because they'd asked, and that might not be the case for other people their age.

Is there anything Jess wishes she had known when she went on the drugs, I ask? “How much it would actually affect me, how well it would work. I worry about worrying... so I was worried about taking it. I didn’t think It would be such a big change. After the six weeks mark I started seeing something different. I know she didn’t want to get my hopes up but I think they should have more faith in it so when you leave the doctors you come out thinking ‘this is gonna work’.”

“We’ve been doing this since the 1980s, and from a big picture point of view, how’s it turned out for our youth? The data shows it’s turned out terrible” – Robert Whitaker

Drugs might work on an individual scale, but we need to ask how useful they are as an approach to treating a wide scale mental health epidemic, and to what extent they are the cause of one, says Whitaker. When it comes to overmedicating, he believes Britain should learn from America’s mistakes. “We’ve been doing this since the 1980s, and from a big picture point of view, how’s it turned out for our youth? The data shows it’s turned out terrible.” He says that America hasn’t seen a decrease in the burden of mental illness, and they don’t, on the whole, see youth on medication more likely to thrive as adults. “How these drugs effect the brain over the long term is shown not to be good,” he says. “Data and science tells us this has been a fiasco, doing great harm to our youth. The whole categorisation of kids in youth needs to be fundamentally rethought – the science doesn’t show it helps on a collective level.”

With NHS waiting lists for therapy so drastically long, with no guarantee of it working, it’s easy to see why young people are seeing medication as a short term solution to depression and anxiety. I was put on a 10 month waiting list for CBT around the same time I was put on anti-anxiety drugs. Clearly, the UK government needs to look at our plan for reducing the growing number of people with mental health problems, so that statistics for the number of young people on medication goes down, rather than up, in the long term.

And in the short term? YoungMinds impress that if you are experiencing feelings of anxiety and depression, you should still definitely see your doctor. But it’s the doctor’s responsibility to evaluate the best possible treatment, and Bush reminds us that GPs shouldn’t be prescribing antidepressants to young people unless it’s alongside talking therapies like a counsellor, cognitive behavioural therapist (CBT) or similar. "There can be a place for medication in treating young people's mental health problems,” acknowledges Bush, “but it shouldn't be used as a sticking plaster for poor access to talking therapies.”

James isn’t sure how long he’ll be on the drugs, “maybe until the anxiety and depression goes away or I find some better ones”, while Jess is about to have her dose doubled, because both she and the doctor feel they’re working, but that they could be doing more for her. Sarah on the other hand, has put a time limit on things: “I’m grateful that medication is available even though I know it’s not a permanent solution for me,” says Sarah. “It lets you see a more stable and positive viewpoint for you to aim for, but I want to come off these tablets after one year so I’m about to start CBT. The drugs are helpful, but I kind of want to get to the bottom of the problem.”

*some names changed to protect identities