Marwa Helal

Another Prozac Nation?

More people than ever are turning to medication to deal with depression

On the surface, they are pictures of professionalism and success. Noura is a 27-year-old editor for an international news website. Ahmed is a project manager for a software developing team in Cairo. Beneath their poised exteriors, however, they battle with depression every day.

(Names have been changed to protect the patients’ privacy.)

For Noura, depression came on suddenly about three years ago. She was diagnosed after being taken to a psychiatrist for a nervous breakdown. Ahmed was diagnosed four years ago. A top student and athlete, he has been successful throughout his life, but says his depression did not come on suddenly.

“For as long as I can remember, I’ve never really been happy,” he notes. “It was my military service that brought it to an unbearable level.”

When he finally did visit the doctor, “I was surprised to see how crowded the waiting room was,” he says.

While there are no solid statistics on the number of people suffering from depression in Egypt, medical professionals have noticed a significant increase in the number of cases. According to Dr. Aly Mokhtar, a consulting psychiatrist at the American University in Cairo and member of the Royal College of Psychiatry in the United Kingdom, “there has been a recent increase in Egypt, as well as an increase worldwide in the number of people seeking help and counseling. As a result, there has been an increase in the number of people using antidepressants.”

The increase is most apparent in the 18–28 age range, with young adults struggling to cope with increased competition for jobs, changing family structure and even culture shock.

“Many young adults [being treated for depression] are the product of two cultures,” Mokhtar says. “They have been brought up in the Gulf region or elsewhere where their lifestyle is more sheltered and limited.”


While most people manage to weather the turmoil of growing up, some cannot cope. It is natural for a person to feel depressed from time to time. The problem is when the feelings persist.

“As [someone] becomes more distressed and feels [his] problems are unsolvable, this sense of helplessness can often lead to feelings of unhappiness and lack of motivation and turn into full-blown depression,” Mokhtar says.

He advises that if the depression “takes up most of the time of most of the days of four weeks—that is the point when you should seek professional help.”

When depression starts affecting a person physiologically, it is medically known as “depressive disorder.” Symptoms include a disturbance in sleep, a change in eating habits or appetite, lack of energy and concentration, a loss of interest in favorite activities and a preoccupation with negative inner thoughts. At this point, a doctor can prescribe antidepressants to treat the symptoms.

“Antidepressants are quite useful drugs and the majority of them—when used properly—are safe and do not cause addiction,” Mokhtar says, but then warns, “The use of antidepressants alone is not a complete solution.” The medication addresses the symptoms, not the root problem; patients need to receive counseling and medical follow-up while taking the drugs.

“There is a problem with prescribing antidepressants because sometimes antidepressant therapy becomes the easy option and doctors resort to [it] too quickly,” Mokhtar asserts. He also claims it is too easy to obtain the drugs: “The reality is antidepressants are available over the counter in Egypt.”

Noha Hamama, a pharmacist and manager at Seif Pharmacies, says any reputable pharmacy requires a prescription signed by a doctor before dispensing antidepressants. “They are like any drug. The human body builds up a tolerance to it and if the patient and the dose are not monitored it can have the complete opposite effect [of making the person feel worse]—in some cases leading to suicide.”

There is another reason not to selfmedicate: A person may be ‘treating’ the wrong problem. Depression is sometimes confused with general anxiety disorder, marked by persistent feelings of dissatisfaction and agitation; the symptoms are also a part of bipolar disorder, when the patient fluctuates between feelings of mania and depression. Both illnesses require medication but not necessarily antidepressants.

Someone To Talk To

Mokhtar believes that, in some cases, medication is not always necessary. “Depression can be treated through talking problems out, writing them down and taking simple steps to feel empowered again.” Nevertheless, he still recommends antidepressants for severe cases of depression. “I think a client has the option to take the drugs or not, they need to be talked through why they need the antidepressant and for how long.”

It’s important to talk with the right person. A psychiatrist is a medical doctor who is trained to diagnose and treat psychiatric disorders through medication and other therapies. A clinical psychologist, on the other hand, is qualified to offer counseling, but cannot diagnose a psychiatric condition or write prescriptions.

Finding a good psychiatrist is key to coping with depression. “The problem nowadays,” Mokhtar says, “is that psychiatrists are short on time with so many patients.”

Noura had problems finding a good psychiatrist in Cairo. “It really scared me when my doctor would write a prescription based on any negative feelings I shared, to the point where I stopped telling him if I had cried or had been feeling lazy, in order to avoid an increase in my dose or a change in my medication,” she says.

After visiting three psychiatrists, Noura found one who counsels as well as prescribes medication. “She has been the best because she actually takes time to [understand] what I have been going through before writing out a prescription.”

Even supported by a good doctor and medication, patients still have to deal with the stigma of having a mental illness.

“My parents don’t want anyone to know I have it,” Noura says. “They fear that no one will want to marry me.”

Ahmed hasn’t even told his parents he has been seeing a psychiatrist or taking antidepressants. “I think this is something personal that I need to deal with alone.”

Social stigma is compounded by religion. Some claim that if the person’s faith were stronger, he would not have a mental illness. Mokhtar says this is completely wrong: “While faith can help us during stressful times, it is not a measure of mental health.”

Even with medication, depression still affects the person’s self-perception. “I feel pretty normal,” Noura says, “but the pills I have to take are a daily reminder that I’m not.”

Noura may feel that way, but the casual observer is hard-pressed to notice anything wrong with her or Ahmed—or a neighbor or a coworker. It begs the question: Is Egypt becoming another Prozac nation?

“We have to ask, is depression becoming more common,” Mokhtar ponders, “or is it that people are aware that there is something called depression and are more prepared to seek help?”

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