Depression and why shaming those who take pills risks lives

As if those people with depression didn’t have enough to contend with, anyone who switched on BBC1’s Panorama this week will have been confronted by one of the most irresponsible and stigmatising pieces of television made in years.

A Prescription for Murder? looked at an alleged link between antidepressants and violence and mass killings.

My heart sank because these kinds of programmes are so unhelpful — sensationalising the subject matter as if it was a crime show. Yet they get commissioned because they claim to be doing a public service; airing an important concern.

Actually, all they end up doing is resonating with people’s prejudices about those with mental illness: that they are all axe-wielding maniacs. They do nothing except cause fear and worry for a vulnerable and misunderstood group of people who really don’t need this.

Now don’t get me wrong, it is absolutely the right of others to express their view. And even though i’m a doctor and i prescribe antidepressants every day, i don’t think they are the be-all and end-all.

Depression is complex, and an approach that tackles it from several angles is the most effective. This means psychotherapy is important, too.

But television programmes like this play on the idea that such medication is, by its very nature, dangerous; and on the insidious idea that those with mental illness should be feared. it then goes that if antidepressants are evil, those who take them are tainted by association.

The usually perspicacious, measured and penetrating Panorama lost all perspective and got sucked into perpetuating stigma and ‘pill shaming’.

What upsets me is that after these kinds of programmes, there are inevitably some people who stop taking their medication and, as a result, they deteriorate.

it’s not the producer or, indeed, anyone at the BBC who has to see the fallout. it is the GPs, psychiatrists and psychiatric nurses working on the front line who have to deal with patients who are suicidal as a result.

Of Course, the pharmaceutical industry has not covered itself in glory, and this makes their products easy targets for spurious claims. We know that over the years they have cherrypicked the data they use so it ensured more favourable results.

This has made the job of clinicians very difficult because it means that truly evaluating how effective these drugs are is tricky. it’s problematic anyway, because the brain is such an incredibly complex organ that we don’t fully understand how it works — nor, indeed, fully the mechanism by which antidepressants work.

But the fact is there is no clear, definitive evidence to link antidepressants with violence. The programme relied entirely on anecdote and hearsay and the speculation of individuals who had experienced awful crimes and, understandably, wanted something to blame.

This is not evidence, though. Where was the empirical research demonstrating clear causation? There was not even a whiff.

And i worry about how all this affects those in desperate need of treatment. it is true that in some situations antidepressants are given out too readily. Harassed GPs faced with patients with complex social problems and eight minutes to sort them out reach too readily for the prescription pad.

There is no pill that is going to make your philandering husband change his ways, your screaming, ungrateful children better behaved or your bored wife love you. This isn’t an illness, it’s what is termed ‘rubbish life syndrome’.

But the flip side is that while antidepressants are in some quarters overprescribed, in others depression is woefully underdiagnosed and under-treated.

A horrifying study by the London school of economics a few years ago showed that while mental illness accounts for nearly half of all ill health in the under-65s, only 25 per cent of those in need of treatment get it.

further research by Aberdeen university showed that GPs failed to diagnose major depression in half their patients. some of the highest rates of under-diagnosis occur in middle-aged and older men, who also have the highest rates of suicide.

A National Confidential inquiry into suicide showed that fewer than 10 per cent of people who killed themselves had been referred to mental health services in the previous 12 months.

This is the true scandal about antidepressants that Panorama should be focusing on: the fact that we are failing to identify and treat people who have a crippling and life-threatening condition.