Icelandic teenage girls are taking antidepressants in ever-increasing numbers. Since 2012, the number of girls aged 15-19 who have been prescribed antidepressants has rocketed up by 85.7% and the dosage strength has increased by 120%. While there has been a general increase in antidepressant prescriptions across the board, no other group has seen a higher increase than these young women.
“We have to focus on the roots of the problem,” says Ólafur Einarsson, a project manager at the Directorate of Health. “Why is there so much despair and is there a way to guide people to feel better?”
For the last few years, Iceland has topped the league tables for the country with the most antidepressant users, despite the fact that the country does not appear to have higher rates of depression than other nations. This raises several questions: are teenage girls struggling more with their mental health than other demographics or are they just more likely to seek help? And are doctors too quick to write out a prescription where something else would suffice?
Over-reliance on medication
Ólafur does feel that antidepressants are overprescribed. “They are supposed to be the last resort. We have to focus on other treatments,” he says. “Some people say that the best preventive treatment for any illnesses is exercise—and that’s not only exercise in fancy workout gear in an expensive gym, but just a walk or an easy run. In fact, doctors can prescribe for exercise—it is called ‘hreyfiseðlar’ or ‘activity prescription.’”
Anna Ólafsdóttir, General Manager of the Icelandic Mental Health Alliance, agrees that GPs are too quick to prescribe antidepressants and feels that many young people seeking support for their mental health would benefit from speaking to a counsellor. “Between 500 and 600 people come to hospital because of self harm each year and most of them are young women,” she says.
One study on self-harm carried out at a college in Iceland revealed that 27.5% of girls between the ages of 16-20 have hurt themselves at least once. Unfortunately, the scarcity of free or affordable psychiatrists and psychologists at the first level of healthcare in Iceland means doctors seem to be relying on antidepressants to treat sufferers instead.
“Parents have to pay a lot for their children to visit a psychologist and many don’t have the money to do that,” Anna continues. “So many GPs give children medicine instead of therapy. That means the big question is whether we take so much medicine because we don’t have access to therapy.”
Too much, too young
Unfortunately, simply acknowledging that doctors may be prescribing too many antidepressants does nothing to determine why so many girls are seeking mental health support to begin with. Anna refers to her colleague, a psychologist who works in a college, who says many students come to him with feelings of anxiety without being able to pinpoint the cause.
“They’re in school, they’re in sports, they’re working and also having a great social life,” she says. “In so many cases, he tells them it’s just too much. You have to live a simpler life. But they say that there is nothing they can cut out.”
Gunnar Hrafn Birgisson, a clinical psychologist who regularly sees young female clients, says teenage girls often come to him with issues relating to self-esteem. “Disliking themselves is very common,” he says. “They dislike their body and compare themselves with someone they think is perfect. They think this is how they should be and they don’t fulfill the criteria.”
He adds that research suggests that spending a lot of time on smartphones and computers has also been linked with increasing anxiety and depression levels amongst both female and male adolescents.
Making things better
Regardless for the reasoning behind these growing levels of distress, it’s unlikely that prescribing teens increasingly high doses of antidepressants is the best solution. “These medicines can have side effects and it’s questionable if they address the reason people get depressed,” says Ólafur. “Most practicing doctors in Iceland are prescribing antidepressants for patients on the first visit. Maybe this should only be in the hands of more specialised physicians.”
In the meantime, Anna recommends that in order to reduce their stress levels, teenage girls should try to reduce the expectations they place on themselves. “Try not to be too occupied by how beautiful you are on Facebook, or being able to reply to everyone’s texts and be there for everyone and just take some time to focus on yourself,” she says.