Where old is gold again: antidepressants in Nepal, 1961–2021

The so-called psychopharmaceutical revolution began in the 1950s, with apparently ever better drugs coming to market. Amitriptyline (Elavil), introduced in 1961, was one of the first ‘antidepressants’. Over the next decades, many other antidepressants came out, including fluoxetine (Prozac). In the...

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Bibliographic Details
Published inBioSocieties Vol. 17; no. 4; pp. 601 - 618
Main Author Ecks, Stefan
Format Journal Article
LanguageEnglish
Published London Palgrave Macmillan UK 01.12.2022
Palgrave Macmillan
Subjects
Affordability
Amitriptylene
Amitriptyline
Antidepressants
Clinical research
Clinical trials
Drugs
Efficacy
Fieldwork
Fluoxetine
Global local relationship
Health care policy
Health policy
Insomnia
Original Article
Placebos
Prescription drugs
Psychiatrists
Psychiatry
Sleep disorders
Social Sciences
Nepal
Amitriptyline
Antidepressants
Psychiatry
Global mental health
Nepal
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Summary:The so-called psychopharmaceutical revolution began in the 1950s, with apparently ever better drugs coming to market. Amitriptyline (Elavil), introduced in 1961, was one of the first ‘antidepressants’. Over the next decades, many other antidepressants came out, including fluoxetine (Prozac). In the 2000s, critiques that antidepressants were no better than placebos could not slow down a massive global rise of prescriptions. In 2018, a large meta-analysis of clinical trials argued that antidepressants were indeed better than placebos, but that none of the new drugs was as effective as the old amitriptyline. 1961 is also the birth year of psychiatry in the Himalayan country of Nepal. Since the 1960s, Nepali psychiatrists have been using amitriptyline as their first-line drug. The inclusion of amitriptyline in the first WHO list of Essential Drugs (1977) cemented its status. All the ‘new’ psychopharmaceuticals came to Nepal, but they never displaced the ‘old’ amitriptyline. No other drug could beat amitriptyline's affordability, availability, and efficacy for the typical Nepali depression patient: a ‘somatizer’ who suffers from multiple bodily aches, insomnia, and anxiety. Fieldwork with Nepali psychiatrists reveals the tenacity of local affordances over global changes in evidence and health policy.
ISSN:1745-8552
1745-8560
DOI:10.1057/s41292-021-00233-9