El Ciudadano
Original article: Sobre por qué Chile se medica cada vez más
By Verónica Aravena Vega
The use of psychotropic medications has doubled in just seven years, raising questions about the effectiveness of the healthcare system in addressing widespread distress. The only remedy prescribed by the system for collective discomfort is often administered individually, along with a glass of water.
In a healthcare clinic located in a community where half the residents are in the lowest income bracket, mental health consultations are almost instantaneous—lasting only as long as it takes the doctor to write a prescription. Clonazepam for sleep troubles and sertraline to get out of bed are common prescriptions. Patients then face a month-long wait for a follow-up while they stand in line at the pharmacy. Psychologist appointments exist only on paper, not in any real calendar.
Chile has more than doubled its antidepressant consumption in seven years, rising from 46.5 to 94.3 daily doses per thousand people between 2015 and 2022. Over two decades, the increase is even graver—from thirteen doses to over ninety. Medications for mental health are now the second most commonly used in the country, behind heart medications. This striking statistic highlights the two organs we medicate the most: the one that pumps blood and the one that thinks.
None of this is entirely new. Chile has been reliant on sleep medications for decades, and dependence on benzodiazepines has been recognized as a public health issue for many years, especially in a country with ample reasons for insomnia. What has changed is the speed with which prescriptions have become the default solution for any internal distress.
This rapid increase can be traced back to specific dates. Between 2019 and 2021, the consumption of these medications surged from 147 to over 220 daily doses per thousand inhabitants—significantly more than half of that increase occurring in just two years. Two consecutive shocks, a revolt and lockdown, provided a collective experience shared on the same streets and through the same news outlets. The culmination of these collective events resulted in millions of individual prescriptions being filed away, each with a different patient’s name.
Two narratives coexist regarding this trend, both providing a sense of comfort. The first is optimistic: people are finally seeking help and acknowledging their issues. The second, more critical, suggests we are over-diagnosing; the so-called ‘snowflake generation’ struggles with resilience. One perspective celebrates the statistics while the other criticizes them. However, neither questions what is causing the distress that the medication is intended to silence.
Mark Fisher articulated this before his own depression led to his untimely death: late capitalism took a political condition and reinterpreted it as a private chemical failure. Grief transformed from something inflicted by the external world into a problem that affects one’s serotonin levels. The trick is deceptively simple. When the problem is framed as residing in your head, the treatment is conveniently located on your nightstand, leaving unaddressed the unaffordable rent and the boss who messages at 11 PM.
In the public system, this approach is the only option available. Therapy requires time and money that those insured under Fonasa do not have, so mental health conditions among the poor are often reduced to a blister pack of pills. The waiting list for specialized care stretches to months, sometimes over a year, and no level of distress can endure such delays. In communities like Recoleta, where more than half of the population falls into the lower-income category, prescriptions for psychotropic medications coincide with what studies cautiously refer to as social determinants: unemployment and persistent debt. Prescriptions leave these underlying issues where they are, providing little more than temporary relief.
There has been a mental health law since 2021, but this sector receives less than two percent of the health budget, and that fraction has decreased instead of increasing with the prescriptions.
Meanwhile, the criteria for diagnosis have become elastic. Grief that persists after three months and insomnia experienced by those tallying their finances at 4 AM are now classified as treatable, and both patients leave with their prescriptions. What once was a tough patch in life, something that could be endured alone or together, has now been reclassified with codes and doses. Normal sadness in response to a difficult life has been recategorized as an episode, and every episode calls for its medication.
There is a typical consumer, and it is not a coincidence. One in four women aged 45 to 64 takes tranquilizers. Tranquilizers are one of the few types of medication consumed more by women than by men, and use increases with age, arriving early in life and lasting. They serve as the chemical solution for a life narrative built on caring for others without compensation and suppressing complaints. Silvia Federici aptly named this unpaid labor; clonazepam is the common prescription when the weight of this work finally becomes unbearable.
Conversely, men consume significantly fewer tranquilizers but commit suicide four to five times more than women. Prescriptions can keep women going to continue caregiving, while the system barely prescribes anything to men, leading many to face the darker statistic—one that cannot return to the pharmacy.
The pill also represents a business opportunity, and in Chile, this industry has its dubious history. Three chains dominate the market and have been penalized for colluding to raise prices on dozens of medications. When Recoleta opened its popular pharmacy in 2015 to buy directly from manufacturers and cut out the markup, it starkly illustrated the disparity: Ipran, an antidepressant, was priced around forty thousand pesos at the chains but just over two thousand at the municipal pharmacy. The same antidepressant at a fraction of the price, and on the other side of the counter is a country grappling with increasing consumption, one of the few markets that continues to grow steadily because customers return every thirty days and remain brand loyal.
The money spent to sedate an entire nation’s exhaustion could fund the conversations that the country lacks. A mental health law exists since 2021, yet less than two percent of the health budget is allocated to this field, and that allocation has actually decreased despite the rise in prescriptions. Dialogues leave no room for margin; the profit margin is what remains.
When the appointment doesn’t come or the medication runs out, people still buy their remedies. Those in search of treatment are determined; they just lack access. During the pandemic, unauthorized consumption soared. Clonazepam can be found sold at street fairs, tucked among clothing and household goods, and in messaging groups where people resell leftover medications from their monthly supplies. Some pharmacies dispense retained prescriptions without requiring paperwork, as those behind the counter understand more swiftly than the system that an individual will be worse off waiting on the list. Here, illegality merely serves as a shortcut for those who find the legal door closed: with no appointment at the clinic and no funds for a private psychiatrist, the only accessible mental health care is that which exists outside the formal system.
The pill addresses distress similarly to how it dissolves in water—one person at a time. Each individual is left alone with their chemistry and guilt, while the world that sent them to the pharmacy remains unchanged, awaiting them again the next day. By the end of the month, the clinic’s waiting room fills again with the same familiar faces, each leaving with their box of medications and a scheduled follow-up for thirty days later.
By Verónica Aravena Vega
Doctorate in Gender Studies and Politics. University of Barcelona. Master’s in Masculinities and Gender. Master’s in Human Resources. Master’s in Social/Organizational Psychology. Follow on Instagram
The views expressed in this column are the sole responsibility of the author and do not necessarily reflect the opinions of El Ciudadano.
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