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Antidepressants: A Deeper Look at the Results & the Real Stories
There’s an uncomfortable reality with antidepressant usage statistics in many countries around the globe.
If we take the UK as an example, 428 million antidepressants were prescribed between March 2020 and March 2025, with 91 million prescriptions alone in 2024, the highest annual total on record. Even more, since 2020, prescription of antidepressants has risen by more than 40%, indicating that medications are a preferred method for managing mental health issues.
And yet in 2023 (the last full year of suicide data from the Office for National Statistics (ONS)) the suicide rates for both males and females in England and Wales was at its highest level since 1999.
The reality is uncomfortable because at a glance, it seems like a reasonable question to ask: “if more antidepressants are being prescribed than ever before — then why aren’t things getting better?”
Dr. Albert Viljoen, a General Practitioner and ICF-accredited leadership coach, told me about the “Treatment Prevalence Paradox”, where logic dictates that if we have more “cures”, such as medication, and better access to them, then disease rates should drop.
So what’s happening, and why?
A Complex Mental Health Picture
The truth is, mental health is far more complex than a simple black-and-white equation. It’s impossible to paint one neat linear line from A to B and draw definitive correlations in stats.
One could argue, for example, that given the positive wave of mental health awareness in the last decade and push towards patient self-advocacy, perhaps more people feel comfortable speaking to a healthcare professional and being prescribed treatment.
So we’re seeing both more antidepressants prescribed and more people registered in statistics.
And context matters. While the world has moved on from COVID-19, many people’s nervous systems haven’t. We spent many years being told, whether explicitly or indirectly, that the outside world wasn’t safe, to stay indoors, to avoid in person social interaction. This caused mental distress in a huge percentage of the population, and many people’s coping strategies, things like seeing friends, physically attending a therapy session, or going to group exercise classes, were unavailable.
We are medicating the symptom (low mood) without also addressing loneliness, sedentary behaviour, poor diet, lack of purpose and lack of agency.
So for some, antidepressants and medication served as a much-needed support system. And it’s likely we don’t know the full extent of the long-term impact of COVID-19 and how much it’s skewed the figures we’re seeing.
But we also can’t avoid the fact that many of the statistics aren’t improving in the way that we’d like, particularly given how much exposure they’ve had in recent years. So we have to ask the question of whether our approach, societally and systemically, is working.
For Dr. Albert, this and the Treatment Prevalence Paradox confirms to him that “we are treating the smoke, not the fire. We are attempting to use a biological override for what is often a lifestyle and environmental issue. We are medicating the symptom (low mood) without also addressing the ‘depressogenic’ environment: loneliness, sedentary behaviour, poor diet, lack of purpose and lack of agency.”
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Over-Medicalization and Marketing Spin?
Treating the smoke rather than the fire is a concept that lies at the heart of the book Lost Connections from Johann Hari, which takes a radical, sometimes controversial look at depression, anxiety, and antidepressant usage.
Hari draws the conclusions that we’re seeing such staggering rates of poor mental health around the world, despite access to treatment, because of the connections we have lost: to ourselves, to our friends, to our purpose, and to the world around us.
There are inherent biological factors and brain changes at play for many, but for others, the root cause lies in the psychological disconnection between the self and meaningful work, or a deep-rooted feeling of loneliness and lack of belonging.
These things can’t be cured or solved alone through medication. It may treat the symptoms of what we feel from these things, but it doesn’t change the root cause, and if we don’t address that, we may find that antidepressant usage becomes a life-long plan.
Dr. Albert said “we are trying to medicate our way out of a crisis of connection and purpose. We have pathologised normal human distress. Grief, burnout, and existential angst are increasingly categorised as “Major Depressive Disorder”. When we label a “life problem” as a “brain disease”, the medication might numb the pain, but we don’t treat the contributing causes.” Antidepressants can also cause what Dr. Albert described as “emotional blunting”, where individuals may find themselves feeling numbness to any emotion at all.
There are two larger avenues to be explored, which touch on questions of culture and societal norms, as well as the morality of money-making actions of big corporations.
The first is over the different approaches to medicine in the East vs West, where, as Dr. Albert says, countries in the West like “USA, UK, and Australia consistently top charts for antidepressant prescription. The West is hyper-medicalised, where we see the self as an individual machine; if the machine breaks, we replace the part.”
Antidepressants represent what some may see as a “quick fix”, which fits an often-capitalist narrative in the West: we fix the machine (our bodies) quickly, and get back to work. Countries like Eastern medical systems have historically taken a more holistic or somatic approach to health; one that focuses on body-work before psychiatry, and one that recognises the link between the mind and the body.
Although it’s worth noting that there has historically been more stigma towards mental illness in Asian societies, and Dr. Albert tells me that “prescription usage is now climbing to match ours as these societies “Westernise” by adopting high-pressure, individualistic work cultures.”
But the point here is that generally, Western medicine has taken a very prescriptive approach to a problem that often runs much deeper and wider. Mental health problems aren’t always viewed through the lens that they should be, one that looks holistically at both the individual and the environment around them. It’s easier to prescribe a patient medication than it is to also work on systemic and cultural change too.
And that leads us to the second avenue that must be explored, the role of big pharma. As Hari notes in his book, big pharma had a huge role to play in promoting the “Chemical Imbalance” theory, which stated that depression is caused by an imbalance of neurotransmitters like serotonin. It was an easy concept to understand, and the solution became even easier to get onboard with: if depression is only due to a chemical imbalance, then if you take antidepressants, that will fix everything.
Hari examines how so much of this was a marketing spin, and big pharma knowingly omitted certain results and hard truths from their focus group studies in order to have their antidepressants flood the market. It seems that money talked louder than morals. Dr. Albert labels it “the biggest medical marketing success of the 20th century.”
What is critically important to communicate is that none of the above discounts the role that antidepressants play for so many as a vital, and sometimes life-saving, form of treatment. Hari’s book is an important contribution to the space, and yet has also drawn criticism for cherry-picking evidence, presenting one narrative, and over-simplifying theories.
While it is generally widely accepted now the role that big pharma played with over-marketing the Chemical Imbalance theory, depression and mental ill health does still involve complex neurobiological mechanisms, and as such patient treatment is a complex process. Antidepressants play an important, often live-saving role, for many, and are a critical tool in many treatment journeys.
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The Life-Saving and Life-Changing Role Antidepressants Play
Jessica Robson, who has been campaigning for mental health awareness for many years, told me that she’s been taking antidepressants for roughly 12 years, on and off. She describes some negative side effects, particularly at the start, and wishes she’d been given more of a warning about that. But overall, she said “they play a really important role in my mental health self care. I know that they enhance my enjoyment of life and limit the ‘extremes’ of negative emotion.”
And another, Simon Jay, who himself has been working in healthcare for over a decade and a half, has been on antidepressants for 16 years, said that his experience has been “hugely positive”. Over a few weeks after first taking them, he felt that “the weight of the world wasn’t on my shoulders anymore” and then over the years they’ve been “critical in how I’ve been able to continue functioning.”
Clearly, both Jess and Simon credit so much of their mental health journey to antidepressants, and this is a story shared by countless others, with research showing that antidepressants help with both symptoms and relapse.
The critical part of this, knowing what we know about needing to look at mental health issues from both an individual level as well as a systemic one, is that antidepressants on their own may not deliver the whole solution to individuals.
Exactly what works for one person will be different to another, and there is no discounting the fact that pills might be the biggest tool someone has in their recovery toolkit, but we mustn’t view them as a blunt instrument to a problem that may run deeper than simply chemicals being off kilter.
Dr. Albert said to me, “medication should be a “Supportive Ingredient”. I view antidepressants as scaffolding. If a building is collapsing, you put up scaffolding to hold it steady while you repair the foundation. One of the most important roles of medication is to restore enough agency so the patient can actually do the psychological work. When you are in the depths of severe depression, telling someone to “go for a run” or “eat better” is impossible. The medication lifts the floor just enough so they can stand up.”
Antidepressants, therefore, play a vital role in relieving symptoms of depression, particularly in cases which are severe, and helping individuals get to a level of relative emotional stability where they can follow a normal daily routine. They give many patients the ability to then engage with a potentially wider, more holistic treatment plan, although each person’s plan, and the timelines with it, will differ from individual to individual.
When looking at what a total treatment plan for addressing cases of poor mental health, Dr. Albert said that alongside the role of medication, we must also treat people across all domains:
1. Biological (Physiology): This is where medication can fit, but so does exercise. A 2024 meta-analysis found that for many people, exercise (specifically running and strength training) is 1.5x more effective than counseling or medications alone for managing mild-to-moderate depression.
2. Psychological: Counselling and psychotherapy to address the internal story. “I am broken” vs. “I am healing.” And help with tools such as reframing, self-awareness, meaning-making and finding purpose. Indeed, cognitive behavioural therapy administered by a trained therapist has been shown to be as effective as antidepressant medications and may have more enduring effects.
3. Sociological (Relational): As social creatures, humans have evolved to value belonging. Medication cannot make you feel you belong socially; only people can do that: and this is the area that has suffered the most in digitised, fragmented cultures, causing the rates of depression to rise.
4. Dietary Interventions: A controlled dietary intervention specifically for depression termed the SMILES Trial showed that 32% of participants achieved remission from depression just by improving their diet, compared to 8% in the social support group. If pills are important, so is food, yet we prescribe one and rarely mention the other.
Seeking Mental Health Support
One final important message Dr. Albert gave me was to bust the outdated myth that “if you need pills, you’re weak; if you don’t, you’re strong.” He said that this is simply false, and “stigmatises biology. Taking medication isn’t a moral failure; it’s a tool. The real strength lies in taking the medication and then doing the hard work of behavioural change while the medication supports you.”
Each person’s journey is complex and is unique to them, and it’s important that individuals discuss this with a qualified medical professional. The contents of this article aren’t intended to be medical advice or a medical diagnosis. It is a holistic look at the role of antidepressants, acknowledging both sides of them, but not discounting the hugely impactful and often life-saving role they play for so many.
If you are struggling emotionally, please speak to a medical professional to discuss the best course of action and treatment for you. There are a range of treatment options available, as well as multiple types of antidepressants and therapeutic avenues that can be explored.
If you need immediate assistance, please visit Befrienders Worldwide for a list of global helplines, and the NHS details crisis services for those in the UK.
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This article examines the complex landscape of antidepressant use, exploring prescription trends, treatment efficacy, and the multi-domain approach to mental health care. While acknowledging antidepressants' vital role for many, it discusses some critical environmental and systemic factors as root causes of depression, emphasizing that medications might work best as part of comprehensive treatment addressing biological, psychological, and social domains.
