Every weekday, Ella Wilson wakes up at 7.30am and opens the Instagram app on her iPhone, checking for ‘likes’ on her latest selfie, before getting ready for school.
After packing her rucksack, the 16-year-old A-level student heads downstairs and picks at a few strawberries from the fruit salad her mother prepared the night before – and takes her daily capsule of the antidepressant fluoxetine.
On paper, Ella would seem to be the envy of many her age – slim, undeniably attractive and a gifted dancer with hopes of studying drama at university. She comes from a secure, loving family, with professional parents and two siblings with equally rosy prospects.
But following an attempt to end her life last spring, the teenager has been on medication for depression for more than a year.
It came after six months of therapy which, ultimately, failed to halt the intrusive thoughts that plagued her. That she’d never be pretty enough, or popular enough, or clever enough, and was destined for a lonely, miserable life.
‘I just wanted all the bad thoughts to stop,’ says Ella, who lives with her mother Andrea, 52, father Duncan, 52, sister Sasha, 22, and brother Jack, 20.
‘The pressure of trying to keep up with everyone else never stops. I never feel good enough. I go on to Instagram and see my friends meeting up together and think: why aren’t I there too?
Lucy Waite (centre) wrote her first suicide note aged 12 and has attempted to end her life twice
‘I used to text them and ask what they were doing at the weekend. They’d say nothing, then I’d see pictures of them together online – I just wasn’t invited. I see boys commenting on pictures of girls at school, saying how hot they look, so I think I have to look like that too.’
Exams, of course, are a constant pressure.’Girls lie about their marks, because everyone’s in competition with each other, and then we get found out and it causes rows,’ she says.
One evening in April last year, while her parents were out, she collected up a cocktail of over-the-counter medicines in the house and swallowed them, alone, in her bedroom.
Three hours later she rang her mother in a panic, who called for an ambulance.
Talking about it today, Andrea is understandably still shaken: ‘Ella said she hated herself, and I don’t know why. There’s nothing wrong with her – she’s beautiful and wonderful.’
It is, without doubt, a sad story. But, tragically, it’s also one that is increasingly common. Almost 190,000 young people aged between ten and 19 are now, like Ella, on antidepressants, according to the latest NHS figures – over a fifth more than four years ago. Girls are twice as likely than boys to be prescribed them.
Ella’s older sister – who previously suffered an eating disorder – and several of her friends have taken them, too.
Andrea says: ‘They all talk about what pills they’re taking with each other, and they have so much of the information at their fingertips. I worry it’s almost become normalised.’
Meanwhile, sleeping pill prescriptions for under-18s have increased by a third in two years, while the number of teens being treated for addiction to anti-anxiety medication doubled between 2017 and 2018. Experts raised the alarm, warning that GPs are handing out psychiatric drugs too freely, creating a medicated generation unable to cope with the usual highs and lows of life.
There’s also growing awareness in the medical community about the risk of coming off antidepressants, which alter the amount of mood-stabilising hormones in the brain. At the end of last year, health watchdog NICE changed their guidance for antidepressant treatment, warning that withdrawal symptoms – including suicidal thoughts – may be ‘severe and protracted’ in some patients.
Of course, teenagers have always suffered angst.
So are GPs simply quicker now to reach for the pills, or is there something deeper going on?
Almost 190,000 young people aged between ten and 19 are on antidepressants (file photo)
What is clear is that British children are among the most unhappy in the world.
This year, the Children’s Society reported that our 15 year-olds are among the saddest and least satisfied with their lives in Europe. Even more strikingly, Britain has the second biggest happiness gender gap out of 24 European countries – almost a quarter of girls scored low on several measures of wellbeing, compared to just over ten per cent of boys.
A wealth of studies show that deprivation is the leading risk factor for mental illness.
Those from poorer families are twice as likely to suffer a lack of support, inadequate education and parental neglect – all factors that contribute towards poor mental health.
And yet teenage girls from privileged backgrounds, with all the odds in their favour, are also more likely to suffer than the norm.
Those with parents on an annual income of more than £100,000 show worryingly high rates of substance use, depression, anxiety and eating disorders, according to a recent study.
So what is it that makes our nation so toxic for our children – and in particular our daughters?
Behind every case of depression – and subsequent antidepressant prescription – is a complex mix of genetic, biological and environmental factors. But as a parenting author who tracks the factors affecting child wellbeing, it seems to me there are several themes that keep cropping up.
For one thing, British children spend more time online than almost any others in the world, according to a survey of more than half a million 15 year-olds from 34 countries, by the Organisation for Economic Co-operation and Development, a global organisation whose goal is to shape policies that foster prosperity, equality, opportunity and well-being. More than one in three British youngsters are ‘extreme’ users, who spend at least six hours a day online. Tellingly, the heaviest users are girls – more vulnerable to being sucked into a toxic culture of self-comparison.
For instance, on TikTok – a social media platform on which you’ll find short videos of youngsters dancing or doing comic skits – videos of users deemed unattractive or with an ‘abnormal body type’ are suppressed by the app’s moderators, according to documents leaked to online publication, The Intercept. Inevitably, images of slim, attractive people are promoted to the top of users’ feeds.
It’s just one example among so many of how social media skews young users’ perception of what’s a normal way to look.
Then there’s friendships – key for happiness and self-confidence.
Emily Roscoe says that medication not only saved her from mental turmoil but also physical ruin, as it helped her overcome the deadliest of all mental illnesses – anorexia
Studies show that British children’s social relationships are more tense and fractious than any other nation’s – in part due to the amount of time they spend online. Research at the University of Sheffield found interacting mainly online increases the risk of cyberbullying and social comparison, which can lead to jealousy and conflict.
Added to all this is academic pressure. Tests start with SATS in primary school, at the age of seven, and carry on every year to GCSE and A-levels – more examinations than any other country in the world.
Ministers scrapped coursework in 2017, piling on the pressure to perform in examinations even further. Again, it’s our girls that suffer this the most, largely due to gender differences in coping mechanisms.
Studies show that boys externalise unhappiness – it presents as anger towards others. But girls internalise it, blaming themselves.
Take 18-year-old Lucy Waite, from Surrey, who wrote her first suicide note aged just 12 – and has attempted to end her life twice.
‘Even if my mum tells me I’m fine as I am, deep down I’m thinking, no, fine is not enough,’ says Lucy, who lives with parents Gill, 52, a human resources manager and Doug, 53, who works in sales, and younger sister Sophie, 14. ‘I’ve got to be the best, otherwise I’ve failed.’
Lucy’s mood first dipped in the first year of secondary school when she was 12, when classmates began picking on her.
‘It was weird, they said they were my friends but they were also picking on me. They’d say mean things about the way I looked, throw things at me, or call me a ‘suck up’ if I did well on a test,’ she says.
‘I started to withdraw, spent more time in my bedroom after school and would cry myself to sleep most nights. I’d dread going in from the minute I woke up.’
Her highly selective private school made matters worse.
After a year of spiralling depression, Lucy reached her lowest ebb, and wrote of her disturbingly dark feelings – and the lengths she’d go to, to stop them – in a notepad.
‘I didn’t have a plan, as such, but I could’ve acted on impulse in that moment. I just wanted it all to stop,’ she says.
Thankfully, Lucy’s mother Gill found the note and stepped in, taking Lucy to the GP immediately, before she had a chance to act. The doctor referred Lucy to the local child and adolescent mental health service, and she began therapy. Things improved – to some extent.
‘I started to really struggle with my appearance. I was too tall. And I had muscly legs, not like the other girls’ in my class who were skinny,’ says Lucy.
‘And around the same time, Instagram became popular, so I was in this world of insanely pretty girls, talking about how they stayed really skinny by eating healthily.
‘I thought I want to be like that and thought the way to do it is to lose a load of weight. So I got down to an unhealthy weight, until my parents noticed and intervened to get me to eat.’
The GP prescribed antidepressants – first, sertraline, followed by amitriptylin, along with sleeping pills.
Intriguingly, Lucy knows other girls her age on medication, but says: ‘It’s not really something people talk about.’
Gill was ‘hesitant’ to put her 12 year-old child on antidepressants at first. But having taken the pills herself in the past, she ‘at least knew what to look out for, in terms of side effects’.
Lucy believes the medication has been ‘a lifesaver’. She says: ‘Everyone is different. But for me, it was the right mix. It allowed me to get me through my GCSEs.’
Lucy and Ella are, indeed, the sharp end of the spectrum of mental ill health.
But sadly, suicide among teen girls and young women is rising fast – almost doubling in just seven years, according to Government figures. And without antidepressants, these figures could be far higher.
Suzanne Alderson’s life changed forever when her GP rang to say that her 14 year-old daughter Issy had confided that she was planning to kill herself ‘imminently’.
But the 48 year-old author, from Birmingham, was reluctant to turn straight to medication.
She says: ‘From brain-enhancing supplements to Rescue Remedy [a supplement that claims to support sleep and mental wellbeing], I tried everything else.
I felt like it was my fault that I had a child on antidepressants.’
But soon, with her daughter’s mental health further deteriorating, she changed her approach. ‘I realised that medication can work like a stabiliser,’ she says. ‘Sometimes it’s needed to get a child to a place where recovery seems at least possible.’
It was, in the end, what Issy needed to pull through.
‘If she had needed medication for a physical condition, I would not have questioned it, so why the issue with antidepressants?’ adds Suzanne, who has since founded a 20,000 strong Facebook community, Parenting Mental Health. ‘We have to break down the belief that mental illness is something we can love away. We can’t.
‘We need to change the environment, the expectations – and sometimes we also need to medicate.’
Emily Roscoe says that medication not only saved her from mental turmoil but also physical ruin, as it helped her overcome the deadliest of all mental illnesses – anorexia.
From the aged of 14 to 18 she suffered with the eating disorder, as well as anxiety and depression. ‘I desperately needed the medication to fix the anorexia before I could even think about improving my mood,’ says Emily, 24.
She says she’s through the worst of it, although still takes antidepressants. ‘Without pills there would have been no getting through to me. It would have taken my life.’
What does she think went so wrong? ‘There was no trauma, my parents have good jobs, are university educated and are still together. Growing up we had the perfect childhood,’ says Emily, who works in finance.
‘But there was a lot of pressure to do well at school – it was an Academy that wanted to do well in the league tables. The message was, ‘If you don’t do well now, you will ruin your future.’
‘I started to control the only thing I was in charge of. My weight. I’d be proud of the fact I didn’t eat for days.’
Emily has a similar attitude to Suzanne about the medication that, she says, saved her life.
‘If someone had diabetes, they would inject insulin,’ she says. ‘So why is it taboo that someone with depression should continue to take antidepressants? It’s all medical.’
The general medical consensus is that giving teens antidepressants should be a last resort.
Dr Louise Theodosiou, of the child and adolescent faculty at the Royal College of Psychiatrists, says: ‘They should only be prescribed to young people with moderate to severe illness, who have tried another treatment previously, which hasn’t worked, and are having psychological therapy alongside too.
‘Sometimes they can be prescribed first, but only in a small number of especially severe cases and regular monitoring of possible side-effects is essential.’
The Mail on Sunday’s resident GP Dr Ellie Cannon believes giving youngsters space to talk is key. She suggests doing quiet activities together that don’t require much eye contact – such as cooking, or even going for a walk – helping teens to talk freely without pressure.
For Ella’s mother, Andrea, medication gave her daughter the ‘breathing space’ she needed to think rationally again.
‘I felt like a failure because I couldn’t help her do it through lifestyle and exercise. But the truth is, depression is an illness, and these drugs can help.’
- Tanith Carey is the author of Taming the Tiger Parent published by Constable, and What’s My Teenager Thinking? published by DK. Suzanne Alderson is the author of Never Let Go: How to Parent Your Child Through Mental Illness, published by Vermillion.