WHY DOES ICELAND HAVE THE HIGHEST RATE OF ANTIDEPRESSANT CONSUMPTION?

By Emma Wei

For a long time, Iceland has the highest average antidepressant consumption in the world. Paradoxically, in 2018, Iceland was also the fourth happiest country in the world, according to the UN World Happiness Report. You might wonder, how is this the case?

Although it might sound rather bizarre at first, some scientists suggest that the long, dark winter might be the reason why Icelandic people are taking much more antidepressants than average. Because Iceland sits at the high latitude of 65° N, Iceland only gets 3.4 hours of sunshine on an average day. Scientists have found out that turnover of a neurotransmitter, serotonin, in the brain is proportional to the amount of sunlight you get. Because sunlight triggers the release of serotonin, which is typically associated with happiness and well-being, although the actual function is much more complicated.

Without enough sunlight exposure, low levels of serotonin are associated with seasonal affective disorder. With the long depressing winter, it is estimated that 15% to 25% meaning that residents are expected to experience depression at some point. One of the most commonly used antidepressants, SSRI, prevents the reuptake of serotonin. Therefore, it increases the time serotonin remains between the synapses.

This might help people taking antidepressant feel calm and stay in a better mood, which is similar to the effect of sunlight.

However, the truth is likely to be more complicated. There are several countries, such as Norway, which lie on high latitude. On average, Norway only gets about one hour more sunlight per day. But only 5.6% of the Norwegian population take antidepressants, whilst the rate is 11% in Iceland. In fact, the popularity of antidepressants reflects the conditions much more than the sunlight hours, such as the availability of treatment and cultural stigma in a country.

The advance healthcare system might be the reason why more Icelandic people are diagnosed with depression and prescribed medicine. The healthcare system is largely paid for by taxes, so everyone legally residing in Iceland has access to it. Also, there are 19 psychiatrists per 100,000 population, compared to a global rate of 1.27 psychiatrists per 100,000 population. This drastic difference makes the treatment of mental health illness more available for people residing in Iceland than many developing and developed countries, hence the higher diagnosis rate and higher rate of antidepressant subscription.

Also, despite the high rate of antidepressant prescription, the suicide rate of Iceland is not on top of the chart. This reflects the awareness of mental health amongst the communities in Iceland. Unsurprisingly, the countries which have the top suicide rate, Lithuania and Russia, do not have very high antidepressant prescription rate. Therefore, does the rate of antidepressant prescription also have something to do with the attitude of the people living in those countries?

I found out about the project Geðrækt, which was a project in Iceland to increase the awareness of mental health issues launched in 2001. They brought together as many representatives of stigmatized minority groups within society to work together against stigma. They also did various thing such as discussing the topic mental health on radio every week, and distributing educational materials to kindergarten and school teachers to be informed of mental health illness amounts children and teenagers. This successful campaign reduced stigma around the phrase mental health illness, and enhanced the knowledge of mental health both within and outside the community health care system. Therefore, people in Iceland might be more willing to go to their doctors for mental health issues.

Globally, some culture and communities might view people suffering from mental health illness as being in control of their illness and responsible for causing it. Therefore, the stigma causes only 59.6% of individuals with a mental illness reported receiving treatment as a result of the negative stigma and the lack of access to health care.

Iceland might be prescribing antidepressant more frequently than any other country in the world, but that might not be a bad sign. Instead, it might reflect the equal healthcare opportunities, the positive attitude towards mental health illness, and of course, the long dark winters in Iceland.

Sources:

https://www.webmd.com/mental-health/news/20021205/unraveling-suns-role-in-depression

https://en.m.wikipedia.org/wiki/Healthcare_in_Iceland

https://www.who.int/mental_health/evidence/atlas/profiles/isl_mh_profile.pdf?ua=1

http://worldpopulationreview.com/countries/suicide-rate-by-country/

http://www.psychologicalscience.org/index.php/publications/mental-illness-stigma.html