Joseph Ting: Happy pills

WESTERN culture seems to live by the dictum “I deserve to be happy”, wanting a quick fix and a one-off prescription for happiness.

We are all a little frayed by the destabilising forces and pace of contemporary life. Beyond personal struggles at work and home, society is assailed by economic uncertainty, environmental degradation, overcrowded living, escalating competition and diminishing access to opportunity and health care.

A good start to coping with these pressures is to become more resilient by accepting sadness, physical discomfort and the toil of ageing as part of the course of human life. Learning from adverse experience and lowering our expectations of a satisfactory and happy life are a good start to reshaping life’s journey.

Freud is credited with saying that the most we can hope for is “ordinary unhappiness”, while ancient Greek playwright Aeschylus expected much less, “call(ing) no man happy until he is dead”. However, Socrates believed happiness resulted from having a purpose in life, striving to live a meaningful life and doing good work.

The fixation with and relentless pursuit of happiness can become psychologically burdensome, even destructive.

Most of what life throws at us does not require antidepressants, as that risks medicalising normal human distress and viewing ordinary sadness as mandating drug treatment.

Happiness is based on optimising the rate and flow of neurotransmitters in the brain in the right circuits at the right time. Pharmaceutical marketing claims that this can be achieved biochemically with drugs.

However, this can lead to heightened expectations, with drugs and medical devices used beyond their true capability, with no clear benefit. Time-scarce doctors adopt, and patients demand, the easy convenience of a “drugs first, talk later” approach.

There is no convincing evidence that antidepressant drugs aimed at manipulating our brain neurochemistry benefit those who want to deflect the impact of any brief or mild adverse experience that will eventually resolve without intervention.

Antidepressants are only effective in alleviating debilitating depression in conjunction with close psychiatric care.

Doctors are too readily providing medications when non-drug approaches such as counselling and reassurance could be just as, if not more, effective but without the side effects.

Big Pharma would like doctors and patients to believe depression is a defined disease that functions independently of character and will, and is treatable with antidepressants. To increase antidepressant use, they classify sadness and stress as a disease that merits medication.

Have modern humans really become so much unhappier, or is the reduced stigma of psychological problems, better self-reporting of symptoms, increased willingness to diagnose depression, reduced diagnostic thresholds, increased community awareness and better surveillance contributing to the depression epidemic?

Robert Burton, in the Anatomy of Melancholy published in 1621, gives pause for thought: “The manner of living is to more purpose than whatsoever can be drawn out of the most precious boxes of the apothecaries.”

Dr Joseph Ting is a senior staff specialist in the department of emergency medicine at Mater Health Services, Brisbane, a retrieval and clinical coordination consultant with Careflight Medical Services & Retrieval Services Queensland, adjunct research fellow at Griffith University School of Medicine and clinical senior lecturer in the division of anaesthesiology and critical care at the University of Queensland. He currently works for the East Anglia Air Ambulance in Cambridge, England.

Posted 2 April 2013