Monday, 28 January 2013

Anti Depressants- do they really work?

“Pain could be killed. Sadness could not, but the drugs did shut its mouth for a time.”  Colson Whitehead, Zone One

There is currently a debate around whether Anti depressants are being overused for treating Depression and if there is really a strong enough evidence base for them.

Statistics show that at least 1 in 10 people in the UK suffer from depression, it’s prevalence being slightly higher in women, with 1 in 20 of sufferers being as a result of clinical depression.  Anti depressant prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions and continue to rise.

There is no question that most people with Depression report a reduction in their symptoms though research shows that improvement appears to be due to psychological factors, i.e., the placebo effect.  Evidence is currently inconclusive about how much the Placebo effect is involved. We could ask, how much of the effectiveness of medication is due to the active ingredients and the non Placebo effect?

From my own experiences of working with hundreds of clients with Depression, both Clinical (i.e. from a chemical Serotonin imbalance) and ‘Reactive’ (as a result of a response to an event or stressor), Anti Depressants do have their place.  Many initially report an improvement using Anti Depressants though often, alone they aren’t enough to resolve the underlying factors that cause it in the first place and that help maintain it.  For instance, taking a pill when experiencing work stress may buffer against some of the negative emotional effects though unless the underlying triggers are addressed, things may not change long term. With some clients, Anti Depressants have little effect or in some cases, cause a worsening of symptoms as a result of unpleasant side effects.

Dr Ian Reid, Professor of Psychiatry at the University of Aberdeen, says "Antidepressants are but one element available in the treatment of depression, not a panacea,"…they can have harmful side effects, and they certainly don't help everyone with the disorder. But they are not overprescribed. Careless reportage has demonised them in the public eye, adding to the stigmatisation of mental illness, and erecting unnecessary barriers to effective care." 

The National Institute for Health and Clinical Excellence (NICE) guidelines doesn’t promote the use of Anti depressants as a first port of call for treating moderate depression though instead advocates talking therapies such as CBT (Cognitive Behavioural Therapy) and Interpersonal Therapy initially. Often however, long NHS waiting lists prevent individuals accessing services.  GP’s only option then is to prescribe medication to patients when there are few alternatives available.

Posing my question at the beginning, is there enough evidence to support the widespread use of Anti Depressants; one might argue, if it makes people feel better, why worry about how that happens? Perhaps the individual’s belief in the pill as well as the scientific base causes the improvement.  Often, the therapeutic benefit of talking about our problems and expressing our feelings to a professional such as a GP is part of the healing effect;  ‘It’s good to talk’ as BT says.

The promotion of medication alone however, dismisses the wider implications of creating a culture of ‘pill popping’ rather than addressing underlying causes and socioeconomic factors.   We should be asking why has depression become endemic, not only in the UK but worldwide and how can we change it? In our modern ‘quick fix’ society, we are prone to avoiding the real issues when we need to take a move in the direction of change and start doing something differently. 

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