Much has been made of a recent trial of anti-depressants published in ‘The Lancet’ last week (Feb.22nd 2018). The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”. The authors suggest that many more people could benefit from the drugs and a list of the most and the least effective drugs has been published looking like this:
The most effective:
The least effective:
Doctors are being told to hand out more and more of these drugs and the whole thing is being heralded as good news for sufferers of depression.
I say: be careful.
Whilst this may be the largest study of its type it still has its limitations. Dr. James Davies from the Council For Evidence-Based Psychiatry appeared on BBC Newsnight to say that the study was being spun to wrongly lead people into thinking that the drugs are more safe and effective than they actually are. On The CEP website (cepuk.org) the following post gives an alternative reaction to the study:
‘’Do antidepressants work? The new research proves nothing new’
By admin on 22/02/2018 in News, Psychiatric drugs
The Council for Evidence-based Psychiatry
22 February 2018
For immediate release:
Cipriani’s et al’s new research on whether antidepressants work has generated much excitement in the news media as well as the psychiatric community. The study has been represented by the Royal College of Psychiatrists as “finally putting to bed the controversy on anti-depressants“.
This statement is irresponsible and unsubstantiated, as the study actually supports what has been known for a long time, that various drugs can, unsurprisingly, have an impact on our mood, thoughts and motivation, but also differences between placebo and antidepressants are so minor that they are clinically insignificant, hardly registering at all in a person’s actual experience.
But even these differences can be accounted for. Most people on antidepressants experience some noticeable physical or mental alterations, and as a consequence realise they are on the active drug. This boosts the placebo effect of the antidepressant, helping explain these tiny differences away.
Furthermore, the trials only covered short-term antidepressant usage (8 weeks) in people with severe or moderate depression. Around 50% of patients have been taking antidepressants for more than two years, and the study tells us nothing about their effects over the long term. In fact, there is no evidence that long-term use has any benefits, and in real-world trials (STAR-D study) outcomes are very poor.
Lastly, and perhaps most importantly, the study does not bury the controversy around the damage caused by unnecessary long-term prescribing, the costs lost to the NHS, and the associated harms and disabling withdrawal effects these drugs cause in many patients, which often last for many years.
Overall, the study’s findings are highly limited, and do not support increasing antidepressant usage. Antidepressants are already being prescribed to around 10% of the UK population, and current guidelines do not even support their use by at least one-third of these patients.
This study, and the media coverage that has accompanied it, will unfortunately do nothing to help reduce this level of unnecessary prescribing and the consequent harms.’
From my own experience (having had all of the drugs that on the ‘most effective’ list) I can say that being off anti-depressants has been better for me than taking them. Often I had intolerable side-effects, some of which were unpleasant physically, and some of which were disturbances in my mood leading me to be harsh and cruel and unfeeling, possibly even being the catalyst to some of the most damaging and dramatically bad life choices that I have made. I found that the best drugs only succeeded in flat-lining my mood and preventing me from plunging into overwhelming crisis. However, this flat mood was nothing more than basic survival and experiencing such a constant low mood could barely be called living.
Since coming off these drugs and switching to anti-psychotics I have experienced happiness again, something which was impossible under anti-depressants. Yes, I suffer from crippling anxiety and overwhelming emotions, but at least amongst these emotions there is happiness.
I have found that most doctors have very little knowledge of anti-depressants and very little idea of which to prescribe. It has been almost pot-luck in my experience. In fact, doctors seem to be poorly trained when it comes to depressive illness, which is strange considering the number of patients that turn up in surgeries needing treatment for depression.
We need much more funding for mental health treatment to provide talking therapy and an increase in the availability of adequately trained Psychiatrists and Psychologists.
My advice is, although I hate to have to say it, that medication can actually be worse for you than taking nothing at all. It’s far more important to try a range of talking therapies and alternative treatments. What’s even more difficult to have to say is that with therapies ‘you get what you pay for’. That is, if you have the money to go private and find a Psychiatrist or Psychologist you will find that the quality of your therapy is much better and more useful than you might find on the NHS (where you may have to wait for up to two years to be seen). Save up as much as you can and go private, even for a couple of months.
My conclusion is that this study is not what it is cracked up to be and has been spun to be some sort of big breakthrough – good news on depression’ – when actually the truth is much more complicated and less positive. The attitude of NHS doctors on anti-depressants is not necessarily correct; do your research, get clued up, and be ready to challenge your GPs. Don’t give up on living without anti-depressants because they are not always the answer. This study most definitely does not put the controversy around anti-depressants to bed.