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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. (file photo)

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."
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."
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.

The views expressed in this blog post do not necessarily reflect those of RFE/RL.
A man walks past a Sputnik Serbia sign near the company's office in Belgrade (file photo).

Studio B has been one of Belgrade's most popular radio stations for decades. In the 1970s and 1980s its "Good Morning Belgrade" program was a staple of most Serbian households, and its host, the iconic Dusko Radovic, made sure that all his listeners started the day with a smile. Radovic passed away in 1984, and the country of which Belgrade was the capital city during his lifetime is no more. Much else has changed in the country -- and on the airwaves.

Radovic's old slot now belongs to Sputnik, the Russian state-sponsored media outlet, whose newscast greets Belgraders every morning instead of his cheery voice.

The change is symbolic of Serbia's current role as one of Russia's main strategic concerns in the Balkan region, with Moscow using all the soft power at its disposal to win local hearts and minds.

Sputnik only started broadcasting there in January 2015 -- but it has more than made up for lost time, not least due to the presence of a battery of other Russian media and institutions hammering home the same message. Sputnik is just one out of over 100 pro-Russian media and NGOs, according to the Center for Euro-Atlantic Studies (CEAS), a Belgrade-based think tank.

The head of CEAS, Jelena Milic, explains why Serbia is an easy target for Russian soft power in her study titled "The Russification of Serbia."

"Serbia, as the largest predominantly Orthodox and Slavic country in Central Europe which is yet to become a member of the EU and does not want to become member of NATO, [is] in a dire economic situation with the public exposed to strong propaganda and glorification of traditional Russian-Serbian friendship."

In Milic's opinion, we are witnessing the "Putinization" of Serbia, despite its formal progress toward the EU which should, in theory, preclude the former.

She coined the term "Putin's orchestra" to describe what she sees as the coordinated attempts by individuals, groups, and institutions to undermine public support for European integration, to delay Serbia's rapprochement with the West, and promote Russian interests.

"There is more and more evidence that some members of 'Putin's orchestra' are financed directly from Moscow, she writes.

Political analyst Bosko Jaksic (file photo)
Political analyst Bosko Jaksic (file photo)

Belgrade-based analyst Bosko Jaksic does not see pro-Russian groups and individuals in Serbia acting in a coordinated manner yet, but that may not be far away.

"Without a doubt there is an aim to gather those atomized centers of Russian influence into a single, more powerful unit. Although they are not currently operating on a national frequency, so to speak, we can already see this type of coordination at the local and regional level, and the goal of becoming a major player in Serbian politics is evident," Jaksic told RFE/RL in a recent interview.

Jaksic, who was among the first to observe the phenomenon of the Russification of Serbian nationalism, sees the bastions of Russian influence not only among fringe right-wing nationalist groups, but also in more mainstream political parties -- some of which are members of the ruling coalition -- as well as the Serbian Orthodox Church and student organizations.

"Those are all targets of Russian soft power, and it must be said that Moscow's assessment of the most effective ways of achieving its aims has been proven correct: the promotion of Serbian clero-nationalism, anti-European, and anti-Western sentiment."

"Clearly part of it is the emotional appeal of Mother Russia based on a shared Christian Orthodoxy, Pan-Slavism, and the economic and military ties forged during the time of the former Yugoslavia. The combined effect of all these assaults has led to what I have called the 'Russification' of Serbian nationalism -- in other words, its nourishing [of Serbian nationalism by Russia] in order to swerve the country away from its European path."

The idea of Russian-Serbian brotherhood that is at the heart of the appeal of Russian propaganda is based on a myth, according to Jaksic. However, it is a myth that has been skillfully cultivated by the Kremlin, taking advantage of established Russophilia as well as a strong network of pro-Russian NGOs and institutions.

"Most worryingly, these [Russian NGOs] are especially active at universities, and have been extremely successful in the recruitment of young people," Jaksic says.

Russia's first NGO was formed as far back as 1913, and since then various pro-Russian institutions have been exerting influence on different segments of Serbian society and in Serbian political circles. Jaksic points to the Russian Institute for Strategic Studies that has been promoting so-called social diplomacy and fomenting Serbian nationalism hand in hand with a love of Russia.

"More important still is the promotion of the Russian political model," Jaksic says. "This is the real concern, not because of any anti-Russian sentiment, but rather the promotion of a political idea that is fundamentally opposed to Serbia's strategic interests, the values associated with modern liberal democracy embodied by the EU."

It should also be pointed out that most foreign investment in Serbia comes from EU countries (82 percent) and almost two-thirds of Serbian exports are likewise destined for the EU.

Whether as an orchestra playing in unison or a collection of more or less disparate groups and individuals, the effect of Russian propaganda and influence is being felt in Serbian public life.

In early August, the Office for EU Integration announced the results of its regular survey, which showed that support for EU membership in Serbia has fallen below 50 percent for the first time.

Milic's study identified the University of Belgrade as the main hub of Russian propaganda, and Jaksic finds this most worrying.

Jelena Milic
Jelena Milic

"The [Orthodox] Church is undoubtedly the most powerful transmitter of Russian influence, but elements of the university [of Belgrade] are not far behind. That is both paradoxical and extremely concerning -- that members of the younger generations are being recruited by Russian-backed nationalists, and that Russia is being presented as some kind of alternative and salvation."

There has been an evolution in Russian aims and ambitions, according to Jaksic, from the short-term goal of using scare tactics to block Serbia's mooted NATO membership, to offering an alternative to the EU in the shape of a Eurasian federation, by presenting the EU as a failed project.

"The image of the EU being promoted is of a region that was once blessed with peace and prosperity, that has been shaken to the core by a succession of crises, by rampant nationalisms, by terrorism," Jaksic says. "Such arguments are endlessly repeated to recruit an entire generation of young Serbs who were already losing faith in European integration for other reasons."

The success of Russian-promoted narratives and the spread of Russian influence has clearly emboldened the Kremlin to expand its official presence in Serbia. This is suggested by recent efforts to secure diplomatic status for the staff of the Russian humanitarian center in the city of Nis. This is a travesty, according to Jaksic.

"I have already promised that if the Russian humanitarian workers are granted diplomatic status I will demand diplomatic passports for all Serbian firemen."

While a recent visit by Western officials concluded that the Nis humanitarian center was not currently being used as a base for covert military-intelligence operations, the fear remains that it could be put to other uses.

"While president Vucic appears to be against it (the granting of diplomatic immunity to Russian aid workers) -- in fact last October's visit by [Russian Prime Minister Dmitry] Medvedev was apparently cancelled because the agreement over the humanitarian center fell through -- there are plenty of those in Belgrade who support this and similar moves to appease Moscow," adds Jaksic.

The Nis humanitarian center is only the latest manifestation of Moscow's bullishness in its approach to Serbia, an attitude seemingly vindicated by the shifting of public opinion in its favor and the success of Russian propaganda, especially among university students and the young. However, it also exposes Serbia's real and growing dilemma, caught as it is between what Jaksic describes as its real economic and strategic interests -- European integration -- and the siren song played by Putin's increasingly raucous orchestra in Belgrade.

The views expressed in this blog post do not necessarily reflect those of RFE/RL

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About This Blog

Balkans Without Borders offers personal commentary on contemporary Balkan politics and culture. It is written by Gordana Knezevic, senior journalist and former award-winning editor of the Sarajevo daily Oslobodjenje, as well as the director of RFE/RL’s Balkan Service between 2008 and 2016. The blog reflects on the myriad ways in which the absurdities of Balkan politics and the ongoing historical shifts and realignments affect the lives of people in the region.

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