Forget the doubters, depression pills really DO work
There’s no doubt that depression is a cruel, debilitating and, in some cases, life-threatening condition. exactly what causes depression, though, remains very much unclear. It’s a debate that has raged in medicine for many years. Last week, the debate was reignited with the publication of research into the ‘serotonin theory of depression’: the idea that low mood is caused by low levels of the brain chemical serotonin.
The new research claimed to have debunked this theory and, because the most commonly prescribed antidepressants work by boosting serotonin levels in the brain, this led to much discussion about whether antidepressants are effective.
It is important to say from the outset that this research didn’t actually look at antidepressants at all, just whether low serotonin was the cause of depression.
BuT really this is irrelevant. The idea that depression is simply a chemical imbalance in the brain is clearly a gross over- simplification and I don’t know a single doctor who believes it.
The reality is that depression is an umbrella term — it’s a symptom rather than a medical condition on its own — and there are many, many different causes. It seems likely that it’s caused by a complex interaction of biological, psychological and social factors.
It would make sense, therefore, that rather than one treatment, you would need a number of different treatment options depending on the individual. In the fight against depression you need an arsenal of weapons — and antidepressants are a useful part of that.
I am no fan of the pharmaceutical industry or the way it attempts to manipulate its data to make drugs appear more effective. I also think antidepressants are too readily prescribed and access to psychotherapy is far too limited.
But that doesn’t mean drugs don’t work when they are prescribed properly. For many people they undoubtedly do work.
It’s important to note that several of the academics involved in this latest research are so called‘ critical psychiatrists ’.
In other words, they are academics who disagree with the idea of prescribing medication for mental illness, so their conclusions are, perhaps, unsurprising.
But are we, as a nation, too reliant on antidepressants?
The answer is complicated. It is true that, in some situations, antidepressants may be given out too readily by harassed GPs who have just ten minutes to help patients with complex social problems.
however, there is no pill or potion on this planet that is going to make your bullying boss change their ways, or your bored wife love you, or remove the stress of looking after your ailing elderly parents.
That is not to say these situations aren’t awful but, actually, feeling down about these sorts of things is normal, not pathological. It’s not an illness, it’s what medics call ‘c**p-life syndrome’. Certainly, social situations can trigger a depressive illness, but all too often people who are just responding to unpleasant, stressful and awful situations in a perfectly normal way are given a prescription and pushed out the door. The flip side of this is that while antidepressants are being overprescribed in some quarters, in others, depression is woefully under- diagnosed 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 a quarter of people in need of treatment actually get it.
Further research conducted by
Aberdeen university showed that GPs failed to diagnose major depression in half their patients, with the result that they went untreated.
There are large swathes of the population who are suffering in silence. some of the highest rates of under- diagnosis occurred in older men — who also have the AConFIdenTIAL highest rates of suicide. 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. how appalling.
For people who are struck down with depression, whether low serotonin is or is not the cause doesn’t really matter.
such people need quick, individually- tailored, expert help, whether that’s in the form of antidepressants, psychotherapy, social support or a combination of these things.
The fact that the evidence clearly shows this doesn’t happen for the majority of people with depression is the real scandal and that is what warrants our attention.