‘Prozac generation’: Millions of Aussies take Xanax, Valium
IT'S Friday night and I'm at my local inner-city pub to meet three mates.
All of us went to the same Christian Brothers high school, all of us are from blue collar families and all of us are suffering mental health issues and in various stages of drug dependence and addiction - both illicit and pharmaceutical.
One suffers anxiety and depression, which he treats with a pharmacological diet of legally sourced Xanax and Valium interspersed with blowouts of cocaine and alcohol. He has also used CBD oil, the non-psychoactive component of marijuana, with some success.
Another recently checked himself into Narcotics Anonymous, at my request, for cocaine and alcohol addiction. He suffers anxiety, depression and occasional suicidal thoughts, which he has attempted to treat with meditation apps such as Headspace. Though he regularly relapses into bouts of substance abuse. He's also found some respite micro-dosing ketamine, MDMA and psilocybin mushrooms.
The third has spent the past five years battling ice, heroin and pharmaceutical drug addiction. Ironically, he is the most knowledgeable of us all about the various drugs and their effects.
"It's a lethal combination generally to have a certain amount of benzos (Xanax, Valium etc.) in your system and a certain amount of opiates (Endone, methadone, OxyContin)," he tells me.
"That's what I've noticed from the people I've known who've overdosed - it's always been someone who's a clown and hasn't researched (and) literally doesn't care about drugs, as in what they do to your body," he says.
When another acquaintance joins our table he passes on news of another friend who has vanished after becoming an ice addict. That comes as a surprise to me. The last I'd heard he had a small child, a stable job in the trades and was paying off a unit in Bondi.
For my part, I suffer bouts of anxiety and depression, and the occasional suicidal thought, which I've chosen to treat using the meditation app Headspace, yoga, daily exercise, psychology, healthy eating, the Wim Hof breathing exercise, and trying, as hard as it might be, to avoid alcohol and drugs.
A few days later, another friend who is suffering pain from a herniated disc, confides in me he too is in the grips of depression and anxiety. His doctor prescribed him Valium to help sleep without giving him any idea of what it was, how it worked, or its potential for addiction. "They're not as bad as the life in opiates are they?" he asks me.
Two more highly educated middle-class friends tell me they're on Valium and sleeping pills respectively, too (both benzodiazepines) but have little knowledge of their severity or potential for dependence. When I start describing the various side effects and dangers of mixing different drugs their faces go blank. "I mix Valium and cocaine sometimes. Is that bad?" one asks me.
THE LUCKY COUNTRY
By nearly every metric available, Australia is on top of the world. After 27 years of continuous economic growth, we are ranked third in the world on the United Nation's Human Development Index - a composite of life expectancy, education and per capita income - behind Norway and Switzerland. We might have started later than our European and American counterparts but today we are arguably capitalism's greatest success story. Donald Horne got it right. We are the "The Lucky Country". We are also very unhappy.
Despite our economic success, Australia consumes the third-highest amount of antidepressants on the planet behind the USA and Iceland (a former winner of the UN's HDI index, it turns out).
THE PROZAC NATION
Since 2000, the rate of antidepressant consumption in Australia has more than doubled.
Earlier this week, The Daily Telegraph reported nearly one in eight Australians - some three million people - are on antidepressants today, including more than 100,000 children, an increase of nearly 100 per cent from 50,804 in 2011-12.
More broadly, in the decade leading up to 2016, deaths from accidental drug overdoses, mostly linked to pharmaceutical painkillers, overtook car fatalities in Australia, with a total of 142 Australians dying each month. The majority of those involved a combination of opioids (Endone, fentanyl, methadone) and benzodiazepines (Xanax, Valium, sleeping pills). Suicide is the leading cause of death among men aged 15 to 44, with the most recent statistics from the Australian Bureau of Statistics showing deaths from suicide at their highest rate in 10 years.
"It doesn't seem that mental health generally in the community is very good, it hasn't been looked after, it is under-resourced, and I think we're reaping very much what we've sown," says leading psychologist Professor Michael Carr-Gregg.
WHY ARE WE SO SAD?
The reasons for the increase in prevalence of mental illness, in particular anxiety and depression, are complex but in many ways also quite obvious. They also disproportionately affect young people.
"In the course of our lives, there are a whole lot risk factors that predispose us to depression, (and) there were a whole lot of protective factors that kept us from being depressed. What's happened is the risk factors have gone up and the protective factors have gone down," Prof Carr-Gregg says.
One key protective factor that has been lost is "spirituality".
"Not necessarily religiosity but where you have a sense of belonging, a sense of meaning, a sense of purpose. In other words, you feel part of something bigger than you," he says.
Other factors include loneliness and social isolation, the breakdown of communities, the breakdown of families, access to online pornography for young people, meaningless jobs, and generally living in a highly artificial, often stressful, environment.
"All of those things are on the up, and I think they create more life stressors for a lot of young people," Prof Carr-Gregg says.
Despite our economic growth, Australia also has the highest ratio of household debt to GDP in the world at 125 per cent, with financial stress a leading cause of mental health problems.
Declining mental health among the working population, meanwhile, is costing the country billions.
"At least one in five workers in the workforce are going to have a mental health problem in the last three months. They're going to have major problems with presenteeism - they're turning up but not really being up. We know that costs $11 billion a year to the economy," says Prof Carr-Gregg.
"They now say, according to PwC (Price Waterhouse Coopers), every dollar you invest in mental health (in the) workplace you get $2.30 back. That's a good investment."
AN UPHILL BATTLE
Despite significant investment and attention being delivered to addressing mental illness in Australia, leading experts say structural problems in our healthcare system have left us fighting an uphill battle.
"We make some things that are counter-productive easy," says Dr Jennifer Stevens, a pain specialist at St Vincent's Hospital in Sydney and a board member of Scriptwise - a not-for-profit organisation founded by Kim Ledger, father of Heath, following his son's death from an accidental pharmaceutical drug overdose
"The pills are on the PBS (pharmaceutical benefits scheme), but the exercise programs are not on the PBS so they stay expensive. Inadvertently, we've set up a health system where you get the pills almost free, but all the stuff that has these broader affects on your life they're not free," Dr Stevens says.
Dr Stevens and Prof Carr-Gregg agree antidepressants and anxiety medication, while necessary in some cases, are just a "band-aid".
"Even a psychiatrist will tell you drugs are a band-aid, they are a short-term solution. The main game is talking therapy, change in lifestyle like exercise, diet, mindfulness (really good), and better sleep," says Prof Carr-Gregg.
"If you just take pills that may in fact make it worse when you have withdrawals from your pills. Every time they wear off, your anxiety flares again, so I think it's really important to look at the underlying issues, and it often comes back to taking enough time to exercise which helps with anxiety, with depression, taking enough time out to connect with your friends properly. Just really important things we often don't put a time value on in society," adds Dr Stevens.
THE HIGH COST OF A REAL CURE
Under the current health scheme, sufferers of mental illness are entitled to up to 10 subsidised psychology appointments - down from the 40 recommended by a national health review. Lifestyle modifications - dietary advice, exercise programs, mindfulness programs - are not covered by the PBS, and while psychology appointments are subsidised, with a final cost of around $50 to $80, once the subsidy has been taken into account, the cost of adequate mental health remains significant if not "inaccessible".
"That really does make it very difficult when you talk about repeat sessions of care, and if you're paying ($50 to $80) each time, it adds up quite considerably and makes that kind of care inaccessible to poor people," says Dr Sebastian Rosenberg, an expert on mental health policy at the University of Sydney.
Dr Rosenberg agrees there needs to be an increased focus on alternative treatments to simply handing out drugs.
"One of the critical things missing in the general practitioner's armour, they may well have a PBS (pharmaceutical benefits scheme) prescription pad, what they won't have is a capacity for social prescribing, and here you're really talking about GPs playing a more active role in working with psychosocial organisations, services and others," he says.
As for why powerful drugs are being handed out free and easily while basic lifestyle modifications are being left prohibitively expensive, Prof Rosenberg says: "It's a great question."
"What matters in Australia - and I'm feeling this more strongly than I have for quite some time - all that matters in Australia just about in mental health is who pays, not what works," says Professor Rosenberg.
Follow the money and it leads straight to big pharmaceutical companies like Purdue Pharma who made an estimated $35 billion off the sale of the drug OxyContin, one of several opioids behind the United States pharmaceutical drugs crisis responsible for the deaths of 47,600 people in 2017 alone. The company also spent tens of millions on marketing and bonuses for its sale force team to aggressively pedal the benefits of the drug amid lavish junkets. Prof Carr-Gregg remembers the period well.
"In the '90s I remember you'd get GPs turning up to these most incredible locations. They'd get lavish lunches and lectures, and it was all about pushing a certain kind of drug, and it wasn't just psycho-pharmacological drugs, it was virtually any drug. Big Pharma, there was a huge industry in giving away freebies, you know, shoe polish with a logo on it etc. It was incredible. Those were in the bad old days," he says, adding, "Now you just can't do that. It's against the law. Big Pharma has been regulated."
So what should the role of pharmaceuticals be in the treatment of mental health issues?
"It's an excellent question," says Prof Rosenberg.
"And one that has never really been dealt with in five national mental health plans.
"What is the appropriate role for medication in quality care? We don't know."
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Jed Smith is a freelance journalist. Continue the conversation @Jed_J_Smith