Now the Prozac nation will take a new path

Those "end of the world is nigh" sentiments have always found their most extravagant expression at the close of the century. Look at the millenarian movement that surfaced around 1600. The difference this time around was the way those doom-laden feelings were reinforced by subsequent events: 9/11, the tsunami, Iraq, Darfur, melting ice caps. Graft this gloom on to a few personal misfortunes and millions believe they have every right to feel anxious and depressed.

So we slump in front of our tellies and no sooner have we finished watching the (bad) news, than along come ranks of minor celebrities, all with the same subliminal message: "Not only am I younger, prettier and slimmer than you, but every aspect of my life from my lover to my lunch is more interesting and exciting than yours."

There's nothing like an evening in front of the box to engender what the French call a "cafard", which incidentally also means cockroach. Celebrities are a bit of a double whammy in the depression industry because when they're not making us fell drab and boring, they're telling us how depressed they are, in spite of their dazzling lives. Open Hello! and there are Patsy Palmer, Stephen Fry, John Hannah, Alastair Campbell, Frank Bruno and the rest giving us their take on the illness that will strike down one in five of us. This may have helped dispel the stigma around mental illness, which is helpful because people used to suffer in silence or slit their wrists.

However, in the knowledge that "it can happen to any of us", we're all traipsing off to the surgery with our ragbags of distress, confident that we will emerge with a diagnosis and something to make us feel better. Our ancestors had a world view in which life was not expected to be a picnic and you tholed your situation. But it is implicit in our instant gratification society that, just as doctors have replaced ministers as authority figures, so prescriptions have replaced prayers. Yes, it's happened to me. A few years ago life seemed grey, sleep was elusive and I kept losing the rag with the kids. "You have depression," announced the GP matter-of-factly and I remember feeling not only relief but palpable pleasure that my feelings could be labelled.

In 2003, I met an Irish former GP called Terry Lynch, who had spent years doling out successive generations of anti-depressants with increasing unease. "Each time we saw the same pattern. A new drug appeared. People liked it. The profession loved it and hailed it as a wonder drug. Then 10 to 20 years later problems arose and the truth emerged that at best this drug made no difference."

Since the advent of the new generation of anti-depressants, SSRIs (selective serotonin reuptake inhibitors), of which Prozac and Seroxat are the best known, things have got a lot worse for several reasons. Because the old tricyclic drugs made people sluggish, they tended to make them fat, a big disincentive especially for women. It doesn't apply to SSRIs, which have become positively trendy. Secondly, much larger numbers of people are taking them. Thirdly, in a small number of cases these drugs seem to trigger anxiety and aggression. Some patients have committed suicide shortly after being prescribed SSRIs.

Lynch's response was to retrain as a psychotherapist, having come to believe that his patients would be better off having a good cry than popping pills. Recently both Nice, the body that rations medicines in England, and its Scottish equivalent, the Scottish Medicines Consortium, have recommended that in the first instance mild to moderate depression should be treated by talking therapies and other alternatives to drug treatment. Yet the number of prescriptions for anti-depressants continues to rise. In Scotland, for a reason never satisfactorily explained, we spend around twice as much on anti-depressants per head compared with the rest of the UK, though levels of depression are roughly the same. Perhaps GPs reach for the prescription pad because alternatives, such as talking therapies, are in such short supply. That's why Scotland spends 10 times as much on drugs for depression and anxiety as against clinical psychology.

Make no mistake. Prozac and Seroxat are indeed wonder drugs for some patients. Patients such as the LSO cellist who emerged from two decades of abuse and self-mutilation within a month of beginning a course of Seroxat. Even those such as Dr David Healy, who has led the campaign against the over-prescription of SSRIs, wouldn't ban them because he has seriously depressed patients for whom the benefits outweigh the risks. The problem, as he sees it, is that those with mild depression are being given the idea that these drugs are harmless, when many patients have distressing symptoms, including anxiety attacks and electric shock sensations when trying to come off them and, in a small number of patients, SSRIs seem to make their condition worse, not better. In the US, one manufacturer, Eli Lilly, has made several out-of-court settlements, with no admission of liability, after claims, which the company deny, that some new patients killed themselves or others. Of course, it is difficult to distinguish between the effects of the drug and the impact of the mental illness it is intended to treat.

More significant for most are three facts: 1. one-third of patients get better within four months without any intervention; 2. placebos are only 10% to 15% less effective than anti-depressants; 3. counselling or alternative therapy, such as exercise, are at least as effective as drugs.

Two studies out this week come down on the side of "ecotherapy", such as a daily walk in the park or countryside. In much of Europe agricultural work is used as a treatment for mental distress. The Dutch health service includes 600 "care farms". All credit to the SNP for including in its manifesto a target of reducing prescriptions for anti-depressants by 10%. Now it has the reins of power, Alex Salmond must put his money where his mouth is and spend new money on alternatives. We also need a public information campaign warning of the possible side-effects of anti-depressants and lauding non-drug-based treatments. I'm grateful to my GP for not reaching for his pad. We talked and shortly afterwards I took up jogging, the ultimate "feel good" exercise. OK. So now I'm addicted to running but give me trainers over Seroxat any day.