Image: Tero Kyllönen / Yle

More than 400,000 people per year in Finland receive compensation from the Social Insurance Institution (Kela) for anti-depressant medications. Some 50-70 percent of users take the drugs to treat depression.

Others take them to treat anxiety, chronic pain or sleep disorders, explains Esa Leinonen, professor emeritus of psychiatry from Tampere University.

"Anti-depressants often become appropriate at the point when depression clearly begins to affect someone’s ability to function, to manage day-to-day life and look after his or her work and social responsibilities,” Leinonen says.

Pharmacological treatment is not always used even in cases of moderately severe or serious depression, though. According to Helsinki University psychiatry professor Erkki Isometsä, the most common reason for this decision is the patient’s refusal to take medication.

"There are many reasons for refusal. Some people have at some point tried pharmacological treatment and suffered from unpleasant side effects. Some have heard or read about how much harm drugs may cause,” Isometsä tells Yle.

Research indicates that 7.4 percent of adults in Finland – a nation of 5.5 million – annually experience depression that meets the diagnostic criteria for the illness. Isometsä estimates that as much as 10-20 percent of the population may suffer from at least mild symptoms of depression.

Many take pills for years on end

Jaana Suvisaari, a research professor at the National Institute for Health and Welfare (THL), points out that many take anti-depressants continuously for years.

"Long-term pharmacological treatment usually follows a number of bouts of serious depression. Maintenance treatment is prescribed in an effort to prevent its recurrence. Maintenance treatment means a period of medication aimed at ensuring that symptoms do not return.

Leinonen says that there is a 50-80 percent likelihood of depression reappearing later in life. After a second period of depression, patients typically need at least a year of maintenance treatment, he says. Those who have suffered three or more bouts of depression require long-term, sometimes even permanent maintenance treatment, Leinonen adds.