Happiness, antidepressants, addiction and American politics

Is happiness a political question?

Any politician that does not have the environment at the center of his political platform in 2021 is “ubuesque”, and not fit for office.

The question of happiness would probably qualify at this point too. When a sizeable segment of the population reports a similar problem which interferes with the functioning of society, it leaves the personal sphere, and in this case the medical one, to enter the political one.

Yet, politicians almost never list mental health well-being or the ability to cope as part of their focus — with maybe an exception for Marianne Williamson’s weird and slightly misguided 2020 presidential bid.

I took away one lesson from reading “Sapiens” by Yuval Noah Harari last year: sometimes what appears natural or “ineluctable” is actually a political decision with huge long-term implications. In this specific case, the political decision is inertia or leaving mental health decision-making to profit-seeking ventures.

Antidepressants and addiction rates as signs of our inability to deal with “the suffering of being”

Nearly 77 million out of 328 million American were supposedly taking psychiatric drugs in 2020 [IQVIA] which include ADHD, anti-anxiety and anti-depressants medication. I write “supposedly” because it is impossible to obtain precise information on these prescriptions which in itself is already a political question. Of these 77 million patients, 45 millions are taking an anti-depressant. The Federal government’s health statisticians figures — which are dated — claim that one in every 10 Americans takes an antidepressant and about 14 percent of all Americans above 12 years old.

To this medicated population, we would need to add the self-medicated one. The CDC recently reported that 13 percent of Americans either started or increased their use of addictive substances as a way to cope with the pandemic last year. The opioid epidemic can be linked to the staggering 72,000 overdose deaths the US reports yearly.

Of course there is a clear overlap between thee two groups but one could safely estimate that at least 25% of Americans have experiencing unhappiness and are using prescription drugs or addictive substances to deal with it.

I am not singling out the United States in this piece as other nations, including mine, France, are facing similar uptake in anti-depressant consumption and addiction rates. In fact global sales of anti-depressants were expected to have doubled globally from $14.3 billion in 2019 to about $28.6 billion in 2020.

Antidepressants are life-saving medications

I am not disparaging anti-depressants either. They are life-saving medications and constituted a positive revolution starting with the very popular Prozac in the 90s. I took Viibryd for several years and am truly grateful for a drug which I needed.

I lived next to a disaffected Psychiatric Hospital in Connecticut most of last year where I would take pandemic walks with my sons. There are thousands like it in the US. Looking at this immense abandoned campus, I would often ask myself where did the thousands of patients that lived there go. The response is obviously … home. Anti-depressants helped to open asylums and allowed a large number of mentally ill people to be treated on an outpatient basis rather than impatient.

Andrew Sullivan (who I rarely get to quote in a positive light) described in 2016 how his mother suffered before this revolution and how she was taken away from him as a result: “I absorbed a lot of her agony, I came to realize later, hearing her screams of frustration and misery in constant, terrifying fights with my father, and never knowing how to stop it or to help. […] She was taken away from me several times in my childhood, starting when I was 4, and even now I can recall the corridors and rooms of the institutions she was treated in when we went to visit.”

Prozac, Lexapro, Abilify and other miraculous drugs did put an end to similar suffering by millions of families.

Yet, antidepressants are not the solution for most people reporting dysphoria

While anti-depressants were the solution to debilitating depressive disorders, they quickly turned into a systematic way to deal with the suffering of being. Instead of focusing on the political questions it raises such as the sustainability of our way of life, economic system, social interactions or the availability of non-prescription ways to deal with dysphoria, Governments subcontracted their responsibilities to private pharmaceutical consortiums.

As a result, the pharmaceutical industry is clearly pushing for overprescription of lucrative drugs — a practice which was recently highlighted during the opioid crisis but which clearly goes beyond that specific category of medication. In fact most anti-depressants are prescribed not by psychiatrists but by primary physicians. Everybody but the patient, is happy with this situation.

While the drugs were initially intended to be used for 6 months at most, most people are now on them for several years. One-quarter of people on anti-depressants have used them for a decade or more, according to data from the National Center for Health Statistics. Right before the pandemic, the Wall Street Journal, as an example, was raising the alarm on the banalisation of the long-term use of these very potent medication.

And there again politicians are not asking themselves who is really benefiting or who decided anti-depressants were the best and only way to deal with the issue. After all there is a wide array of non-medical ways of dealing with the “suffering of being” which are similarly effective and in which society is not investing.

Interestingly enough, the article also points out that pharmaceutics have become the answer to unhappiness in rich white communities, leaving minorities behind and untreated. This could also explain why mental health is not a political question: it has seemingly been dealt with for rich white people — the class American politicians care the most about traditionally.

The West is not more unhappy but it is more medicalized

There is a World Happiness Report ranking run by some obscure UN agency. I looked at the 2020 and 2019 reports while writing this piece. It is a hard read because the report attempts to show the “wealth factor” versus other factors in the ranking but the West is definitely faring better than other countries thanks to its economic and democratic gains. The US ranks 18 out of 153. France ranks 23rd.

However, if you look at the OECD statistics it is also clear that the richer the country, the more it consumes anti-depressants.

The conclusion is that the suffering of being might be the human lot but we have given up on the political question of how to mitigate it by privatizing management of unhappiness to the healthcare industry. An industry which in the US can be deeply dysfunctional, greedy and as the opioid crisis showed, sometimes unethical.

Politician are clearly not immune to unhappiness

Interestingly enough, politicians seem to disproportionately experience mental health issues themselves. Just ask any Capitol Hill staffer to share stories. Sex addiction for Rep. Matt Gaetz, alcoholism for Rep. Tom Reed or anger issues for Rep. Amy Kobluchar, our newspapers are filled with example of how politicians are struggling too. I am not even mentioning President Trump who exemplified the concept of mental health co-morbidity.

Yet, recently elected and openly gay Rep. Ritchie Torres might be one of the only politicians who ever spoke candidly about his mental health struggle and use of anti-depressants. Hopefully, it is a signal that more politicians will acknowledge the “other pandemic”, have a closer look at the role of the pharmaceutical industry and the need to develop a political response to what has become the salient issues of 2021.

Fabrice is the Managing Director for Global Equality Initiatives at @OutLeadership. Previously he was an officer at the UN Human Rights Office and World Bank