Reversing the rate of antidepressant prescribing: a view from Poland

I am happy to see the letter calling for the UK government to reverse the rate of antidepressant prescribing. I hope the UK will spearhead the long overdue changes in mental health systems worldwide. Ashift away from the reductionist medical model and towards socially conscious and responsible psychiatry seems necessary. Unfortunately, what has been called “marketing based medicine” still seems to trump evidence based medicine, not only when it comes to antidepressant prescribing. TheUKmight serve as a wake-up call for countries in the “global south,” adopting imported solutions, or for countries such as Poland, where the harsh neoliberal reforms of the early 1990s were accompanied by uncritical adoption of western psychiatric standards, promoted by drug companies conquering new markets. The social turmoil of the so called economic “shock therapy” was largely medicalised as individuals’ psychiatric problems.

Antidepressant prescription rates are still much lower in Poland than in countries such as the US, the UK, or Australia, but they are growing at a fast pace. This process has now accelerated further, probably owing to the covid-19 crisis. The Polish National Health Fund, serving a somewhat similar role to the NHS, is currently spending about 10 times as much money on subsidised antidepressants as on psychotherapy for depression. Psychosocial services are thus largely unaffordable for people experiencing economic and social deprivation who need them the most. Particularly worrying is that the rising prescription rates in young people are accompanied by a dramatic rise in suicide attempts and suicides among those under 18 years old.

In the public debate, there is little awareness of the problems associated with withdrawal symptoms of psychiatric drugs and little acknowledgment of their possible iatrogenic effects, especially long term, for some people. Awareness campaigns and key opinion leaders repeat the old message of “safe, effective, and non-addictive” drugs that “save lives,” even though research on the anti-suicidal properties of antidepressants is inconclusive, and the opposite effect cannot be excluded.8 9 Hopefully, the countries

that have not yet reached UK prescription rates can learn from the UK experience and avoid repeating the same mistakes.

Dr Radosław Stupak, Reversing the rate of antidepressant prescribing: a view from Poland. British Medical Journal, 2024.