Not-so-happy pills

Are antidepressants the answer?

Use of antidepressants is at an all-time high – since 2008, the year or the financial crash, prescriptions have risen by 8.5 per cent per year. Yet the drugs remain hugely controversial. In a recent study, Danish researchers reported that they cause suicidal feelings when given inappropriately to healthy people going through everyday problems (although the methodology of the research has been questioned by some experts).

Originally targeted at major depression, these medications are now also used to alleviate anxiety, and sometimes to help treat eating disorders, insomnia, obsessive-compulsive disorders and chronic pain.

Antidepressants are a relatively recent discovery. In the early Fifties, doctors administered a drug called Isoniazid to tuberculosis sufferers and noted some interesting side-effects. Their formerly lethargic, largely bed-ridden patients were seen dancing and clapping their hands, and they began to sleep better and eat heartily. When a close relative of the drug was tried on patients suffering from neurotic depression, they too appeared to benefit.

Each new “generation” of antidepressants since has targeted neurotransmitters, particularly serotonin, ever more precisely. But despite this, many question the wisdom of offering antidepressants so liberally.

The most important question is, are antidepressants safe? That depends on how a given individual reacts to the ingredient mix of the particular medication prescribed – and unfortunately, it’s not always possible to know how someone will react beforehand. Although side-effects are becoming progressively milder with each new antidepressant, there’s still the risk of restlessness, nausea, insomnia, weight gain, raised blood pressure or loss of libido. These, the most common side-effects, usually last only a few days, but may continue for two weeks or longer. Some – the older family of tricyclics in particular – are a bad mix with alcohol, and overdosing is possible. That’s why it’s so important that doctors know their patient’s history and something of their lifestyle, so hopefully they can make the most appropriate choice the first time. Even then, it can be extremely difficult.

Do antidepressants work? They almost always alleviate symptoms of major depression, and when targeted carefully they can help with insomnia, OCD and some forms of chronic pain. However, there’s less evidence that antidepressants are the best treatment for generalised anxiety or mild depression.

Finally, is it best to mask symptoms using these drugs, or would it be better to address the root causes of the problem? It can be absolutely necessary to alleviate symptoms in the short term, particularly when there’s a suicide risk. However, the use of antidepressants alone rarely protects against relapse. A short of course of drugs, accompanied by mindfulness-based cognitive therapy as soon as the individual feels a bit better, is the most effective treatment package for lasting benefits.