The use of antidepressants in Canada have more than doubled in a decade. We look at the reasons why.

The Rising Use of Antidepressants in Canada, 2010-2022

This article contains information about the mental health crisis in Canada, as well as shedding light on the upward trend of antidepressant use in Canada over the last decade. Why is Canada of interest? Canada, like many other well-developed Western countries, is seeing a staggering increase in problems related to deteriorating mental health, especially amongst the younger population.

Furthermore, as a society, there doesn't seem to be a clear strategy for how to tackle the problem in the grand scheme of things, and many individuals are left to combat depression by themselves. As last year's data became available, we set out to give an overview of the worsening situation. 

Article Key Points

• Depression is a major cause of disability in Canada, affecting millions annually. As such, Canada faces a mental health crisis, particularly among young adults.
  
  
• Inadequate budget allocation and rising cost of living exacerbate mental health challenges.
  
  
• The consumption of antidepressants in Canada is continuously rising year after year.
  
  
• Reasons may include decreased stigma and improved literacy, but there are also concerns that antidepressants may be used as a replacement for psychotherapy.

Canada's Mental Health Crisis

Depression has been an increasing problem throughout the last decades in most Western countries, Canada included. The World Health Organization (WHO) paints a pretty stark picture – depression ranks as the foremost cause of disability in Canada, affecting around 19 million individuals annually. In a country of roughly 38 million inhabitants, that's pretty grim. According to another source, the Canadian Mental Health Association (CMHA), one in five Canadians grapple with a mental illness, including depression, every year. These statistics underscore the severity of the issue at hand.

The National Institute of Mental Health (NIMH) also reveals gender and age disparities. Women are more susceptible, with a prevalence rate of 10.5%, compared to men at 5.8%, who experience major depressive episodes. Young adults aged 18-25, face the highest incidence of depression. In other words, it seems like young women are faring worse in the current crisis. Still, we should keep in mind that men and older individuals may not openly approach healthcare providers with their mental health problems to the same extent as the younger population and opposite gender, which may partially explain the disparity.

Insufficient Funding Going Forward

Canada's mental health crisis has been the backdrop of political promises and budgetary allocations. The Canadian government's commitment to establishing a permanent Canada Mental Health Transfer, aimed at expanding accessible mental health services, has faced setbacks. The 2023 budget, instead of a promised $4.5 billion, allocated $2.5 billion annually over 10 years through bilateral agreements with provinces and territories. That's roughly 45% less than the previously promised amount. 

In the face of this crisis, the Canadian Mental Health Association has sounded the alarm. The budgetary allocation for mental health in 2023 is deemed insufficient to staunch the rising tide of psychological distress. CMHA's CEO, Margaret Eaton, warns that the budget fails to address the escalating demand for community-based mental health and substance use care.

Right now it seems that as inflation escalates, Canadians' mental health deteriorates. The sudden increase in the cost of living throughout 2020-2022 is taking its toll, leading to heightened anxiety, depression, and suicidal ideation among those affected. Rising expenses also force individuals to cut back on health-related expenditures, such as costly psychotherapy, exacerbating an already dire situation. This indicates a pressing need for more accessible and affordable mental health services.

OECD statistics: Use of antidepressants in Canada from 2010 to 2022, per 1000 people. Copyright © 2023 WhatMedicine.Org.

Increased Use of Antidepressants in Canada

The growing reliance on antidepressants, such as the most commonly prescribed antidepressant Zoloft, highlights the urgency of addressing Canada's mental health crisis. The Organization for Economic Co-operation and Development (OECD) data reveals a steady increase in antidepressant consumption from 2010 (78.8) to 2022 (134.0) per 1000 capita, measured as the average daily dose per 1000 person per day. The figures for 2022 put Canada in the top 3 consumers of antidepressants across the world, right after Iceland (157.3) and Portugal (150.5).

While no sudden spikes are evident from the Covid-19 epidemic, the trend is indicating a continuous rise in the use of antidepressants among Canadians. In fact, the usage has almost doubled in the last decade. According to Insight 10, a healthcare-focused market research firm, the Canadian antidepressant drugs market size reached $1.31 billion in 2022 and is projected to experience a 5.9% Compound Annual Growth Rate (CAGR) from 2022 to 2030, reaching $2.08 billion in 2030. These figures indicate a bleak prognosis moving forward.

Why is Antidepressant Use Increasing?

The prescription of antidepressants has seen a concerning rise, even more so in Canadian children and adolescents. A research study from a couple years ago analyzed data of youths under 18 and found a 36% increase in antidepressant prescriptions between 2012-2016, climbing from 120 per 100,000 to 160 per 100,000 individuals.

Dr. Scott Patten, co-author of the study, expressed surprise at the results in an article by the CTV News network. He noted that the prevalence of depression in this age group has not shown a parallel increase, suggesting complex factors at play. 

Possible explanations for the surge include:

• A decreased stigma around mental health.
  
  
• Improved mental health literacy among the population, leading to greater treatment-seeking behavior. 
  
  
• Decreased availability of mental health services, which could possibly be leading to antidepressant prescriptions as an alternative to psychotherapy.

While the exact drivers of this increase remain intricate, further research is necessary to comprehend the motivations and implications tied to the growing use of antidepressants in Canada. Moreover, it's important to note that a non-parallel increase in depression doesn't mean no increase in depression, just that the consumption of antidepressants is rising faster, relatively. 

The Latest Antidepressant in Canada

As the market for antidepressants grows, more research is put into finding new alternatives. In 2019, the FDA approved Esketamine, a nasal spray derived from Ketamine, as a groundbreaking treatment for major depression. Studies showed notable improvement, where 70% of patients with treatment-resistant depression on Esketamine and an oral antidepressant saw progress compared to the placebo group.

Esketamine's uniqueness lies in triggering brain reactions that facilitate neural regrowth and connection, through the processes of triggering glutamate production in the brain. Esketamine has been available to Canadian adults since 2020 under the name Spravato, and it's the latest antidepressant in Canada, as the most recent FDA-approved antidepressant Auvelity isn't yet available in Canada.

Moving Forward

The use of antidepressants in Canada is a reflection of the nation's efforts to grapple with its mental health crisis. There is an urgency for effective strategies and increased awareness. Canada is only one of many well-developed countries to face similar problems.

As such, the rise in antidepressant usage, coupled with the emergence of innovative treatments, indicates both progress and the need for ongoing research and support. While increased antidepressant usage can not be considered unfortunate in itself, the potential underlying causes paint a worrying picture, which warrants further analysis and new strategies going forward.

Better access to therapy may be a simple starting point, but redefined societal structures and values (social, financial, and moral) may be necessary to consider in a chronically worsening mental health crisis amongst developed countries. 

Author: J. Martin, M.D. 
Last updated: August 30, 2023

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.