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

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Abstract

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.

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Acknowledgements

Fieldwork in Nepal was embedded in two larger projects: the ESRC/DFID-funded “Tracing Pharmaceuticals in South Asia” and the MRC-funded “Confidence in Global Mental Health Research”. I want to thank colleagues from both these projects for their support, especially Ian Harper, Sumeet Jain, Nabin Rawal, Gael Robertson, and Madusudhan Subedi. I also want to thank Aidan Seale-Feldman, Gael Robertson, and Sushrut Jadhav for commenting on an earlier draft.

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  1. Social Anthropology, University of Edinburgh, Chrystal Macmillan Building, George Square, Edinburgh, EH8 9LD, UK

    Stefan Ecks

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Correspondence to Stefan Ecks.

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Ecks, S. Where old is gold again: antidepressants in Nepal, 1961–2021. BioSocieties 17, 601–618 (2022). https://doi.org/10.1057/s41292-021-00233-9

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