The use of antidepressants is on the rise in Bosnia -- one, albeit unwanted, measure by which Bosnia is indeed matching or exceeding European norms.
Comprehensive data is not available, but various indicators show a sharp rise in the use of antidepressants, particularly in the past three years. For instance, last year more than 1 million packages of prescription antidepressants (1,030,898) were reportedly sold in Bosnia, a country of 3.5 million. This represents a rise of 14 percent since 2014, when 887,573 packages were sold.
Meanwhile, prescriptions of the antianxiety drug Bromazepam have shot up from 1,876,811 to 4,302,000 between 2013 and 2015.
These figures are supported by anecdotal evidence from pharmacies in the city of Tuzla, where customers asking for the controlled drug without a prescription are a daily occurrence.
"We often get people asking for Lexaurin (another name for Bromazepam) without a prescription, and when we turn them away they return almost immediately with a regular prescription. How this was obtained is hard to say. But we can confirm that demand for these drugs is rising disproportionately," said one pharmacy employee, adding that monthly sales of Lexaurin regularly exceeded sales of the common pain-relief drug paracetamol.
Various explanations have been suggested to explain the rise in the use of antidepressants and antianxiety drugs in Bosnia, including constant stress, financial insecurity, and general dissatisfaction with life more than 20 years after the Bosnian War.
Around 400,000 people in Bosnia suffer from post-traumatic stress disorder (PTSD). The invisible wounds of the four-year war that ended in 1995 are slow to heal. Yet at the same time many people are convinced that they were able to bear the wartime stresses and deprivations better than the anxieties brought by the peace that followed. The feeling is that they failed in peace, or that the peace failed them.
There is nothing to be cheerful about. Unemployment is a huge problem, especially among young people, many of whom are desperate and are leaving the country in droves. It is therefore perfectly understandable that people are searching for anything to calm their nerves, and antidepressants are first at hand."-- Sarajevo academic Zdravko Grebo
Meanwhile, the generation that grew up after the war has not been spared its psychological effects.
Young journalist Anisa Mahmutovic has written a powerful testimony on how PTSD affects her entire family.
Both her parents suffered from PTSD throughout her childhood, and while it took her some time to understand what was happening, she has since become an expert on the condition in order to help them as much as possible.
Mahmutovic blames the effects of the war for the widespread use of antianxiety medications and antidepressants, but she adds that postwar Bosnian society has only made the situation worse. The common response to feelings of depression and anxiety is to self-diagnose and buy drugs -- many of which are all too easily accessible via illegitimate prescriptions, rather than seeking professional help.
"There are still far too many people who refuse to see a psychiatrist but prefer to buy their own medication," Mahmutovic said in a telephone interview with RFE/RL's Sarajevo bureau.
Sarajevo academic Zdravko Grebo: "The joke at the time [in the aftermath of the war] was that whoever in this city and this country had not gone crazy yet -- that person was not normal."
Prominent Sarajevo academic Zdravko Grebo feels that Bosnia's present reality is as much to blame for the rising consumption of antidepressants as the war.
"The simplest explanation is that [the use of antidepressants] is a desperate reaction to the conditions in the country. I mean the conditions in general -- the politics, the economy, the school system, the disastrous state of the courts and the judiciary, the pressure on independent media, and so on," Grebo said in an interview with RFE/RL. "There is nothing to be cheerful about. Unemployment is a huge problem, especially among young people, many of whom are desperate and are leaving the country in droves. It is therefore perfectly understandable that people are searching for anything to calm their nerves, and antidepressants are first at hand."
Most people simply feel left out, or that they are losing out, and the sheer passage of time and all that is happening around them takes its toll, regardless of one's mental strength. In that situation the easiest thing is to see a doctor or simply buy pills."-- Psychologist Srdjan Puhalo
The country was already traumatized enough at the end of the conflict in 1995, when Grebo recalls asking the country's most prominent psychiatrist, the late Dr. Ismet Ceric, whether there was any precedent for the mass treatment of depression.
"I wondered if we could not all be sprayed daily with antidepressants using crop-dusting planes," Grebo says. "The joke at the time [in the aftermath of the war] was that whoever in this city and this country had not gone crazy yet -- that person was not normal."
Yet Grebo also believes that present-day Bosnia has much in common with some of the more advanced Western European societies where the high use of antidepressants is attributed to the climate and the crushing tedium of life -- or boredom.
"In a perverse way, this is true of Bosnia, too. We're no longer at war, and though we are still suffering from its long-term effects, this is at the same time one boring country in the sense that nothing changes, nothing is moving forward, only the constant and repetitive cycle of political and economic corruption and scandals, disputes with neighboring countries, or between the entities within Bosnia," Grebo says. "This is so mind-numbingly boring that we don't see any individual resistance, much less any collective protest. Apathy reigns because the people have been trampled over. They are stupefied. And we are all just tired and bored.... If only we could have another war!"
This is, of course, a joke, typical Sarajevan dark humor that thrived in the city under siege and that had an infectious effect on many foreign journalists. One reporter, Anthony Loyd, channeled this Bosnian propensity for making light of extreme stress and trauma in his book, My War Gone By, I Miss It So. He had come to war-torn Bosnia in order to deal with his own addiction problems and ended up becoming addicted to war -- going on to seek the thrill in other conflict zones around the world.
Psychologist Srdjan Puhalo: "In the 1990s we had war, but this is now a society in transition in which many people are finding it hard to orient themselves."
The psychologist Srdjan Puhalo also recognizes that while high levels of anxiety and depression have been a constant in Bosnia since the beginning of the war, their causes have changed, and the stresses that afflict Bosnians today are comparable to those of their counterparts in more developed countries.
"In the 1990s, we had war, but this is now a society in transition in which many people are finding it hard to orient themselves," he explains.
"Most people simply feel left out, or that they are losing out, and the sheer passage of time and all that is happening around them takes its toll, regardless of one's mental strength. In that situation, the easiest thing is to see a doctor or simply buy pills," says Puhalo.
However, the head of the psychiatric unit at the Tuzla University Clinic (UKC), Dr. Alija Sutovic, points to the dangers associated with the long-term use of antianxiety and antidepressant drugs, especially without the supervision of a doctor. These include memory loss, emotional detachment, and dependence that sometimes only takes a week to develop but up to two months to overcome.
Sutovic blames the stigma of mental illness as the main reason why so many cases of anxiety and depression are never reported or treated clinically, and explains the prevalence of self-medication.
"We try to dispel these fears and myths, and people who come to the clinic for treatment are quickly convinced of the scientific basis of our treatment, and they can see that it produces results, within certain limitations," adds Sutovic. "We do not have bars on our windows -- this is a modern institution -- and many of our beds are empty because we are able to provide services on an outpatient basis."
The rising use of antidepressants in Bosnia seems to be the sign of a society that is both dealing with the psychological legacy of war, as well as more common pressures and anxieties of a 21st-century society in transition -- albeit one with a particularly grim political and economic outlook.