Huge Study Of Anti-Depressants Published In ‘The Lancet’

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:
 agomelatine
 amitriptyline
 escitalopram
 mirtazapine
 paroxetine
The least effective:
 fluoxetine
 fluvoxamine
 reboxetine
 trazodone

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.’

anti-depressants

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.

 

Ten Ways To Help Your Child Or Relative With Their Mental Health Issues At University

Please note that I am not and never have been a mental health professional. I have been through university with a mental illness and have done a little research. I have children but they have not been through university.

1. Understand the challenges faced by students

Saddled with debt; likely to suffer from stress; under pressure to complete their course and get the qualification they need; living unsustainable and damaging lifestyles that may lead to alcoholism or drug addiction; struggling with abusive or failed relationships; trying to understand their mental health difficulties; coping with the realisation that they are not the top of the class anymore, not such a star on the sports field, not as perfect as they thought; vulnerable to anxiety or eating disorders; dealing with being independent, and experiencing some intense life lessons for the first time: student life is fraught with potential difficulties.

2. Choose the right university

Although this may be dependent upon how many offers your child has to choose from, (and on how much influence you have), choosing the right university has to be done wisely.

You might want to consider things like choosing a university that is close enough to home for you to go and visit them regularly: this could be more important than you might imagine.

Consider being influenced by where his/her’s friends are going.

3. Be influenced by the adequacy of the university’s’ mental health services

Check out the website and read up on the university’s mental health support services. Compare it the other university’s that you are choosing from. Give them a ring and talk about it. Understand how many staff the university employs in the area as this may determine the length of the waiting lists for counselling services. Consider choosing a university that has a specialist mental health advisor.

4. Inform the university about pre-existing mental health issues before arriving

This way a plan of help can be made quickly.

There is more help than you might imagine for people who arrive with existing mental health conditions. They can have a mentor or extended deadline dates, for example.

Being open about these things is much better than suffering in silence and these days it shouldn’t affect your application.

5. Spot the signs of depression

Go and visit your family member at university don’t remain stuck on the end of the phone. On the telephone you can’t read facial expressions and you can’t get a feeling for their circumstances, where they live, where they go. Look at their body language: do they look at you in the eyes or do they look away from you? How much do they smile? Is there something different or unusual about them? Do they sound overly pessimistic and negative about everything? How do they dress – have they lost interest in how they look? Have they lost interest in things they used to enjoy? Have they lost or gained weight suddenly?

If your child or relative is withdrawing from you in any way it may be because they are becoming depressed.

Of course, some people are too hard to read, too good at acting. They are the centre of the action, the life and soul of the party, permanently smiling, doing well in their studies and having a great social life. Sometimes making your friends roar with laughter can be a depressing experience: I know because I’ve done it. In that moment you are the only person not laughing and time seems to stand still. Your night out can’t get any better than being the centre of attention and being Mr. popular. So the only way is down.

6. Educate yourself about mental health

Make sure that you understand that depression does not improve simply by ‘jogging around the block’ or ‘going out for a laugh’. The fewer old fashioned clichés that you use the better. Being knowledgeable and understanding will help you give your child the right advice should they choose to ask you for it and will help you yourself cope with his/her’s challenges.

7. Communicate

Foster the best relationship that you can with them so that you can get them to open up about their problems. Keeping it to themselves is not going to help them at all. These days there is less stigma around mental health but it does not mean that admitting you have a problem is easy. As a parent, you will likely be one of the first people that they can trust with their problems. Being able to talk to you is vital.

8. Encourage them to give counselling a go

Talking therapies work. Talking can be the most effective way of treating some mental illnesses and often it starts with traditional counselling that may be available on campus. Other therapies can follow through referral from a GP or privately.

9. Take the pressure off them

You can take the pressure off them by telling them that it is ok to feel the way that they do. You can tell them that it is better to quit and come home than to suffer with suicidal thoughts. Once home they can work on getting well enough to move on with the next stage of their lives. Getting a degree isn’t the only stepping stone to a successful career.

10. Be a good listener

A good listener does not have to give advice but must listen sympathetically and intently. Don’t zone out. Try and summarise what you think they are saying occasionally to show them that you are listening and don’t be afraid to ask them questions. Whatever you do, don’t start talking about yourself. It’s not about you! Avoid lecturing them or making them conform to your view of the world and how you think they should live. It’s great that they are confiding in you!