EFFICIENCY, that little yellow idol of the age, has a destructive side. A beautiful example surfaces this week, with the Medicines and Healthcare products Regulatory Agency giving warning that doctors are overprescribing drugs to people with only mild or moderate depression. Of course they are: it seems efficient. Where therapy would take a minimum of six professional hours, and long talks with the GP are out of the question because the waiting room is full of physically ill people, a prescription can be written in 15 seconds flat. And there you are: one patient duly processed, one box ticked, and — even more cheering to the overpressed doctor — far less chance that the sufferer will return week after week, haunting the surgery like a black cloud.

Given the stresses on the NHS and on society, this problem of overprescription was made inevitable by the arrival of the near-miraculous SSRI group — including Prozac and Seroxat — which carry fewer side-effects than the old tricyclic anti-depressants. These latter had a pronounced slowing effect, especially at first, and doctors were unwilling to render the subject fat and dopey unless they had to. So they resorted to them sparingly, generally when depression was clinically severe. Prozac and Seroxat, the selective serotonin re-uptake inhibitors of the 1990s, have no such deadening effect. They are useful crutches, often neutralising irrational misery. I know. I spent six months on Prozac, and very handy it was.

However, there are drawbacks. It is a dubious reflection on any society that millions of citizens need to be propped up chemically for years on end (and that’s not counting the children given Ritalin merely to make them suit the education system and the two-job family). But even if that were not a concern, the pills themselves carry dangers. Although the drug companies fiercely contest it, strong anecdotal evidence tells that in a small number of people SSRI drugs accentuate or trigger self-harm. As one psychiatrist put it to me: “Depression is made up of misery and lethargy. If you accidentally lift the lethargy before you get to the misery, you may have an alert person determined to end it all. If I have the slightest doubt, I prefer the old drugs, and a patient who just falls asleep.” It is now considered unsafe to put under-18s on SSRIs, but anybody prescribed one at any age should be watched closely during the first weeks by someone who cares. The frightening reflection is that a lot of depressed patients — even young ones, especially students far from home — have no such watcher.

Doctors, however, are in a cleft stick. Depression is disabling and they are anxious to help. If the pills are a crutch while the causes are dealt with, fine. The real problem is when they are not. Most depression responds to talking, cognitive therapy, purposeful work and attention to nutrition and exercise. But therapy — often the first step to all these changes — is miserably hard to come by, and a doctor who knows that it will be eight months to an appointment is bound to reach for the prescription pad. Particularly if there are grim immutable circumstances — divorce, bereavement, unemployment.

But human beings have other resources. An experiment piloting in Plymouth, after research at the university, is planning to offer books to the psychologically poorly. On hearing this I clapped; but my spirits slumped a little when it turned out that they will be prescribed not fiction or biography, but self-help books with titles such as The Feeling Good Handbook. Well, good luck to it; but perhaps we should consider the wider use of books in handling depression.

Woman’s Hour has got close to that. It asked for nominations for “watershed fiction” which “changed the way you look at yourself or simply made you happy to be a woman”. The results are fascinating. Clearly, a lot of women feel that the watershed consists of wallowing in a torrent of self-pitying tears and persecution mania, from which they emerge cleansed and cheerful. Margaret Atwood’s dystopian vision of sexist oppression The Handmaid ’s Tale scores highly, as does Marilyn French’s miserabilist The Women’s Room, with its insulting affirmation that all men are rapists. The Color Purple relates a young woman’s abuse, and the only male author in the top ten is Thomas Hardy with his Tess Durbeyfield, violated maiden who named her doomed baby “Sorrow”.

Then there’s Rebecca, which is no barrel of laughs either, what with the weird husband and the psychotic housekeeper and the first wife as a dead-yet-still-deadly rival; and of course the abused, impoverished, deceived Jane Eyre. I need only add that The Bell Jar by Sylvia Plath features high on the list, together with Bonjour Tristesse and the prolonged working-mother whine of I Don’t Know How She Does It, and you will see that women often relish a nice sympathetic snivel more than any cheery NHS self-help manual. It came as a relief to find Douglas Adams, Dorothy L. Sayers, Dodie Smith and the tart, unselfpitying Miss Austen elbowing their way into the top 30. And one brave little cadre voted for Cold Comfort Farm, which immortally sends up all the heaving, throbbing pointless miseries of life and literature.

Analysis of the list — and a corresponding one for men — would probably tell us a great deal about how individuals, alone with books, handle the troubles of life in oblique and apparently perverse ways. Curling up with Howard’s End or A Town like Alice may not seem efficient, or shiny, or modern, or quick; but it might work as well as any pill. Perhaps some of the NHS drug budget could be transferred to special libraries, free from glaring screens and shouty newspapers and bossy council signs, with quiet neutral spaces and comfy chairs and perhaps a dozing elderly dog or cat. There would be proper librarians in droopy cardigans, experienced at recommending fiction for secret sorrows. Doctors could prescribe us half-days off work on condition that we clocked into these sanctuaries. The only problem would be controlling the waiting list, especially around Christmas.

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