What happens if you take happy pills?

Hundreds of thousands of people with moderate depression or anxiety have been put on powerful anti-depressants unnecessarily, the country's most senior medical experts will warn tomorrow.

Serious concerns about the overprescription of antidepressants such as Seroxat and Prozac will be spelled out by the two bodies regulating the safety and use of medicines in Britain.

They will advise that for people with mild to moderate depression, or with moderate anxiety, they may be better off seeking other treatment such as therapy or even daily exercise.

After months reviewing the international data on the drugs, known as SSRIs (selective serotonin reuptake inhibitors), the government's drugs regulator, the Medicines and Healthcare Products Regulatory Agency, has concluded that GPs are prescribing far too many pills for people who do not have a serious clinical condition.

They will warn doctors they need to think 'long and hard' before putting patients on the medication.

At a press conference tomorrow, Professor Kent Woods, mental health tsar Louis Appleby, and the chief executive of the National Institute for clinical Excellence (Nice), Andrew Dillon, will give their reasons for the warning.

It is expected thousands of people who are on the medication may want to come off it following tomorrow's announcement, but the experts will warn it is vital that they initially contact their doctor to talk about it. Anyone coming off SSRIs quickly can go through acute and dangerous withdrawal symptoms and become suicidal and paranoid.

Professor Woods will out line the findings of the review alongside the publication of new Nice guidelines to the NHS on the treatment of depression and anxiety.

Seroxat, the best-selling anti-depressant in the UK, will be described tomorrow as not suitable for every patient who is suffering from mild to moderate anxiety. The move comes after The Observer revealed last month that its manufacturer, GlaxoSmithKline, was marketing it to doctors specifically as a treatment for 'social anxiety disorders'.

Every year in Britain, some 13 million prescriptions are written out for SSRIs, such as Prozac. The drugs have enjoyed popularity over the past decade because they are much safer, with fewer side effects than the older tricyclic drugs which could easily kill patients who overdosed.

But concerns about SSRIs have emerged in recent years. Last year the government banned their prescription to people under 18s and they have been linked to a spate of suicides in young people in both the UK and the US.

European health authorities have also warned that extra care should be taken in prescribing SSRIs to people under 30.

The drugs, which were designed specifically to counter depression, have also been subjected to intensive scrutiny by the current health select committee investigation into the influence of the pharmaceutical industry.

MPs on the committee have heard concerns from campaigners that the anti-depressants were prescribed too liberally, with the result that millions of people are taking them with little benefit. Introduced to the UK 15 years ago, anti-depressants have been prescribed for a raft of lesser mental conditions such as anxiety disorders and phobias.

Concerns about the pills' addictive nature have led to fears that patients find it difficult to come off them.

Professor David Healy, a psychopharmacologist at Cardiff University, who has given evidence to the health select committee, called for the drug licensing authorities to go much further than merely trying to restrict the supply of anti-depressants.

'The MHRA should concentrate on telling people a little bit more about the risk of them getting hooked on anti-depressants, rather than simply warning the drugs should not be prescribed to those who are anxious,' Healy said.

An internal memo from Prozac's manufacturer, GlaxoSmithKline, written in 1998, revealed that trials of the drug in children were no better than a placebo when it came to relieving depression.

'It would be commercially unacceptable to include a statement that the efficacy had not been demonstrated, as this would undermine the profile [of the drug],' the memo stated.

The drugs companies involved last night declined to comment.

Death and taxes used to be the only certainties in life. For British women, we can now add another one: depression. Statistics may show that one in four women becomes depressed at some time, but a magazine survey this week claims that more than half of British women have taken antidepressants.

Unofficially at least, depression is an expected life experience for women, slipped in somewhere between having children, looking after elderly parents and either divorce or retirement. Is life now so difficult for women that it's normal to be depressed?

Claire Jones is 35 and has just come off antidepressants after a period of depression that started in January last year. 'Everything just got on top of me. My boyfriend had had chronic back pain for some time and he had to take early retirement. He was always snapping at me and couldn't help with the children. My three-year-old wouldn't go to nursery without screaming, so I was constantly late for work. My oldest daughter kept getting chest infections so I was forever being called out of meetings to collect her from school.

'I work in the leisure industry so everyone was meant to be nice and helpful, while I couldn't stop crying. I'm sure I did need the antidepressants. But my mother says that, while she thinks I'm lucky to have career opportunities, it also makes life harder. So much more is expected of my generation. Many of my female friends have been on antidepressants.'

The magazine survey follows one by Norwich Union last week into the prescribing patterns of 250 GPs. Eight out of ten said they prescribed more antidepressants for both depression and anxiety (the two often go together) than they should do. Many of these prescriptions are likely to be handed to women.

'Women are more likely than men to go to their doctor if they feel depressed,' says Fiona Jackson of the mental health charity Mind. 'They aren't frightened of their GP; they are used to going because they've been there when their children have been ill. They are more willing to talk about being depressed and it may be that some have read about Prozac and ask their doctor for it.

'We think antidepressants are being overprescribed, but they can be life-savers for some people. However there is an idea out there that the new antidepressants, called serotonin selective reuptake inhibitors (SSRIs) such as Prozac, are wonder drugs. They are heavily marketed to GPs. Since they were licensed 12 or 13 years ago, prescriptions for them have risen by 700 to 800 per cent in the UK. Depression is a debilitating disease but there may be some people who feel a bit down who get Prozac from their doctor.'

Research shows that men are as likely as women to become depressed, but less likely to seek help. It's not clear if depression is triggered by different life events in men than women.

'All the studies show that women complain more about depression than men,' says John Birtchnell, a consultant psychiatrist with an honorary appointment at the Institute of Psychiatry in London. 'But it is difficult to decide if this means that women are more prone to depression than men. At least they acknowledge it. Men are more willing to deny it.'

Birtchnell believes that, however common depression is among women, it may not always need drug treatment.

'Interpersonal relationships don't play a very prominent role in the training of doctors. Since everything else doctors do is medical, when a woman comes in who isn't feeling happy, they think antidepressants will help. It takes longer to help someone through a difficult time.'

'People tend to forget that being depressed is part of being human. Its normal to have emotions, they are built into the brain. They reveal to us that all is not well and if we didn't get depressed we wouldn't know that. It's like pain - the body's way of saying something is not right. If you went through life without pain you wouldn't know if you had injured yourself or not.'

If a woman tells him about her life situation, Birtchnell says she may say that she has nothing to be depressed about, that she has a lovely home and children. When he asks about what does get her down, it may be something like the neighbours playing their music loud at night.

'It's helpful to reassure people that it's normal for something like that to get them down. Often they'll have been told by friends that they shouldn't feel depressed. The opposite of the medicalisation of depression is seeing the reasonableness of being depressed. No one is happy all the time.'

Deenesh Khoosal, a consultant psychiatrist and spokesperson for the Royal College of Psychiatrists, says that women are more attuned to their feelings than men and are less likely to deny their distress. 'Women are receptive to distress and do something about it. They know the correct terminology for depression and take appropriate action. Men may go to the boozer instead.'

But there is no doubt that depression is not the prerogative of articulate Western middle class women. 'There used to be an old adage that people in central Africa were too poor to be depressed,' says Khoosal, 'but we know it's not true. Depression happens everywhere, but is only diagnosed when people have access to health care and know the terminology. In some cultures there is no word for depression, so it's hard to pick up problems. In others there are phrases that mean the same - like "having a heavy heart".'

A study of depression and anxiety in Pakistan, published in the British Medical Journal this month shows that rates there are higher than Britain, with more than half of women and a third of men having either anxiety, depression or a mixture of both. Women blamed such factors as having too many children, not enough money and fights with husbands and relatives - many of the things which make women in Britain depressed.

Depression is generally defined as mild, moderate or severe. 'At the mild end there are plenty of things women can do,' says Khoosal. 'Their depression may be due to negative life events, such as poor housing, or their husband has just crashed the car. The help they get may not be medical at all but more social manipulation. If the depression is moderate, they may see their GP or may just need a sympathetic listener.

'But severe depression needs expert psychiatric help. If situational things are responsible then you need to change the situation. But sometimes, for example, if a woman's partner is dying of lung cancer, then you can't do anything to change the situation except try to help her understand what her partner will go through.'

Mind is concerned that the talking treatment that works for depression - cognitive behavioural therapy - is expensive and hard to come by on the NHS. 'There is a real shortage,' says Jackson. 'Cognitive behavioural therapy is well proven, but seen as the Rolls-Royce of treatments, whereas writing a prescription is quick and easy.'

In the United States, psychologists are starting to do research into what makes people happy. Jacquie Hetherton, a lecturer in clinical psychology at Royal Holloway in London believes that this research could lead to treatments for depression.

'Psychologists are looking at how to get people who feel OK to feel really good - to feel as though they are leading the good life. They are asking what are the factors that make people happy. Peoples' values may not be linked to happiness. Research shows that if you are "financially comfortable and a bit more", then getting more money won't make you much happier. If we can identify what makes people happy then we can help them avoid slipping into depression.'

Part of Hetherton's work in cognitive behavioural therapy already tries to do this. A lot of depression involves people having negative thoughts about themselves. We train people to be their own therapists and make fundamental changes to how they think.

'We get people who are depressed to re-engage with what made them happy before. Usually when you are depressed you withdraw from your friends. We get them to reverse that. Lots of the women and men I see have tried counselling, acupuncture, reflexology, St. John's wort. But cognitive behavioural therapy gives people a way of observing what is happening to them and helps them to stop it.'

In the midst of the attention around women's rates of taking antidepressants, Mind is anxious that men are not forgotten.

'Women do have more stress, but many of them grow up with networks of friends for support,' says Jackson. 'The real issue is the rate of suicide among men, in particular the young men who kill themselves.'

How many tablets do we take for the blues?

· The Royal College of Psychiatrists puts the total cost of adult depression at more than £9 billion. Only £370 million is treatment costs (drugs, hospital appointments, GP visits); the rest are indirect costs, from days off work to death from depression.

· In 1995, 13.2 million prescriptions were written for all types of antidepressants.

· In 2002, 26 million prescriptions were written for serotonin selective reuptake inhibitors antidepressants such as Prozac.

Tales of two generations

'There was a lot of stress when we were growing up in the 1930s. There was so much unemployment and even when the men were in work they were paid a pittance. Women held the family together with very little. My mother made stews out of marrow bone. But I never thought of her as stressed although she was frustrated because she didn't want to be just a housewife.

'When I got married and had my children there was more of a community spirit. We used to chat over the garden fence for hours. We would talk about the problems we had with our children and husbands. Our families were around to help. I didn't know of any women that worked. You often thought things were tough but you put up with it, you never considered there was a way out. It was easier to relax in some ways because the children played outside so you could have a break from them. The news about paedophiles frightens mothers into keeping their children close by - they are terrified if their children are a few minutes late home.

'Women these days don't want to be a shadow of their husbands. They want their own lives. The media tell them how much they can have but with that comes so much more stress and anxiety. There is no doubt that working women do a hell of a lot more than men. When they get home they start all over again.'

· Joan Williams is 75. She has four children and three grandchildren.

'I can start work at 8am and work to 7pm. I have a stressful job. But most of my friends have a hard time juggling work with looking after children. Most of us feel guilty. It's the women who do the school runs. And if we don't meet our work deadlines we take the work home. There are higher expectations for us, from work, children and our partners. In trying to meet these expectations we are losing good-quality life.

'When I hit 40 it was really hard. I had a mid-life crisis. I became anxious about everything - flying, driving. My father became ill and I was driving 70 miles each weekend to see him. Then my mother became ill. We were trying to sell our house. I had a big project and a demanding client at work. I couldn't sleep properly and I was snapping at everyone. My GP said I might want to think about taking antidepressants. I did think about it but decided not to. I thought there was enough going on in my life to make anyone feel down and that if my life was going to continue to be like this I would always have to take antidepressants. So I took some time off work, spent a few days away with two of my best friends and started looking after myself better.

'My mother would say that her stresses were more day-to-day. Nowadays women worry where they will be in five years' time. We have more choices but choices can be hard. Maybe we aren't good at knowing our limits.'

· Anna Burns is 42. She works as a marketing manager and has three children aged eight, 12 and 14.