Stop mental illness treatment fear-mongering If you think you may be suffering from depression, don’t be dissuaded from seeking help
“I need to stop this medication,” my distressed patient sobbed, “I read that they are hurt more than they help. They have a 33 per cent chance of killing me!” Thus began a lengthy conversation of risks versus benefits, of quality versus quantity and of how statistics can be misleading. It is a conversation that, as a physician, I seem to be having a lot lately.
Depression is a debilitating illness for which there are effective treatments.
Depression’s symptoms include the inability to feel pleasure, a profound lack of motivation, fatigue, psychological pain, inappropriate feelings of guilt, impaired concentration and, often, physical pain.
Put bluntly, depression is a disease that can mimic the physical consequences of chemotherapy and the mental anguish of losing a loved one.
The World Health Organization (WHO) estimates that, globally, 300 million people suffer from depression. For comparison, all cancer diagnoses combined amount to 14 million (WHO, 2004). Ergo, for each person battling cancer, 21 are struggling with depression. It is the leading cause of disability in Canada and other high-income countries (WHO, 2004). Fortunately, there are many medications and psychotherapies that can improve symptoms, reduce the length of depressive episodes and lower the risk of recurrence.
Aside from disabling, depression is deadly. Half of the annual 800,000 global suicides are due to depression. Sadly, only half of those with severe depression receive proper treatment.
Statistics can be deceiving, so approach with caution and a healthy dose of skepticism.
A recent meta-analysis study quoted in The Hamilton Spectator properties that antidepressants increased mortality risk by 33 per cent. This type of study gathers its data from multiple studies. If these source studies vary greatly, the ultimate conclusion can be unreliable. This variability is measured by a value called i2. Basically, as i2 increases, the reliability of the conclusions decrease. With a high i2 of 87 per cent, the validity of the finding that antidepressants increased mortality risk by 33 per cent is extremely questionable.
Even if this 33 per cent increase in mortality risk is assumed accurate, it is only a relative risk increase.
Raw data from the supplementary materials indicate that in one study, 65 of the 26,000 people taking selective-serotonin reuptake inhibitor (SSRI) antidepressants died, versus 11 of the 6,529 people who were not. So, 0.25 per cent of those taking SSRIs died, versus 0.17 per cent of those not taking SSRIs. This means that the absolute increase in mortality risk with SSRIs is 0.08 per cent (because 0.25 is 0.08 more than 0.17).
Confused? Try thinking of it this way: if you were given 0.17 per cent of a full scoop of ice cream and your friend was given 33 per cent more — a whopping 0.22 per cent of a full scoop — you would both be very disappointed. You might even say the difference between the amount of ice cream you each have is so small as to be insignificant.
Depression is scary, but depression treatment doesn’t need to be.
If you think you may be suffering from depression, do not be dissuaded from seeking help. Between psychotherapy and medications, there are effective treatments available.
Your family doctor is a great first point of contact. If you don’t have a family doctor, a list of family doctors accepting patients in Hamilton is available through the Hamilton Academy of Medicine (hamiltondoctors.ca). If you are feeling acutely suicidal, the Crisis Outreach and Support Team (COAST) is available 24-7 at 905-972-8338. There is also a dedicated psychiatric emergency department at St. Joe’s Healthcare Hamilton on Charlton Avenue.
As with any medication, if you are currently taking antidepressants and considering stopping, discuss this with your doctor first. They can review the pros and cons, as well provide follow up care so that any recurrent symptoms can be caught early.
Quantity is not the only importance in life, quality matters too.
Are antidepressants really “taking more lives than they save?” It is true that antidepressants have never been shown to save lives, but that doesn’t mean that they don’t improve them. It is admissible to take medications that make you feel better, even if they don’t make you live longer. Medications for headaches, heartburn, nausea, skin itch, acne, arthritis, fever and for the pain from a broken bone won’t make your life longer. By alleviating distressing symptoms they will, however, make room for your life to be more fulfilling.
Depression is a devastating and destructive disease. It corrodes enjoyment, motivation, focus, vitality and self esteem. It has the power to tear a mother from her newborn child, and to turn a vibrant, vivacious individual into a reclusive shell of themselves. What would you be willing to risk for relief from such an illness?