Anti-depression drugs are on the rise in Germany

1. How do anti-depressants work?

Scientists say they don't know exactly how anti-depressants work, but believe they affect neurotransmitters, which are chemicals that pass along signals between nerve cells in the brain. The key neurotransmitters are serotonin, dopamine and norepinephrine.

A common class of antidepressants is reuptake inhibitors, also known as SSRIs, SNRIs and NDRIs. They got this name because once the neurotransmitters release their message they can be reabsorbed by the sending neuron in a process known as reuptake. Low levels of these neurotransmitters are associated with depression.

The theory is that these drugs prevent neurotransmitters from naturally being absorbed back into the brain's nerve cells. They stay, at least for a while, in the space between nerves known as the synapse and help to strengthen the brain's circuits that regulate mood by improving communication between nerve cells.

2. Are anti-depressives safe?

The older generation of antidepressants, such as lithium, can have cardiovascular side effects. But the newer reuptake inhibitors are said to be safer.

"With respect to tolerability and safety there have been huge increases," says Dr. Malek Bajbouj, a professor of psychiatry and affective neuroscience at the Charité, a university clinic in Berlin. But he says all medicine can have side effects and this is true of antidepressants as well.

3. What are the most common side effects of antidepressants?

Each patient is different, but the most commonly documented side effects include nausea, increased appetite and weight gain, sexual side effects, such as loss of sexual desire or sexual dysfunction, fatigue, insomnia, dry mouth, blurred vision.

4. What about the weight gain? Isn't that significant?

It can be significant, but it depends on the individual and the type of drug. Drug companies have been accused of playing down the question of weight gain, and several, including Eli Lilly and Johnson & Johnson, have been fined billions in class action lawsuits in the United States.

Dr. Bajbouj says weight gain is a big concern among consumers and researchers. "When any new antidepressant is studied the first question people ask is about weight gain," he says.

5. Are anti-depressives addictive?

No. A drug is considered addictive if it generates a wish among consumers to continue to take the drug because it produces bodily symptoms. This is not the case with antidepressants, Dr. Bajbouj says.

6. How prevalent are anti-depressants in Germany and Europe as a whole?

The EU average for people on antidepressants is 56 in every 1,000 residents. In Germany, the average more than doubled to 52 per 1,000 residents between 2000 and 2012, according to a study from the Organization for Economic Cooperation and Development (OECD). Overall consumption of antidepressants nearly doubled in EU countries between 2000 and 2012.

Iceland, a non-EU member, had the highest level of consumption among all those in Europe surveyed, which included 18 EU nations and two non-EU nations (Iceland and Norway).

Nearly 30 percent of women in Iceland aged 65 and over took an antidepressant, compared to less than 15 percent in Norway.

Among EU countries the highest level of antidepressant consumption was in Portugal, Denmark and Sweden. Estonia had the lowest consumption of the EU countries.

7. What are the trends for anti-depression drug use in Germany?

A study by the Techniker Krankenkasse, a German health insurance company, showed about 6 percent of all working insured people received at least one prescription for an antidepressant between 2000 and 2013. In 2000, the starting figure was 4.1 percent.

The prescribed daily dosage nearly tripled between 2000 and 2013 - so not only are more people taking antidepressants, but the average dose is stronger as well.

Women were nearly twice as likely to be prescribed an antidepressant as men. Older workers (up to the age of 60) were more likely to miss work and take more antidepressants than younger workers.

People in high-skilled jobs were less likely to be prescribed an antidepressant than those in low skilled jobs and those working social service jobs.

Dr. Bajbouj says the increase in the number of people taking antidepressants in Germany is due, in part, to it becoming more socially acceptable to seek treatment for mental health. He also puts it down to consumer awareness of the drugs and reduced stigmatization associated with taking them.