“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.
