Should we worry about taking antidepressants?
In 2016 over 70 million antidepressants were prescribed across the UK, more than twice the figure a decade ago. Concerns are regularly raised in the press that these drugs might be over-prescribed. There are also claims that the side effects outweigh the benefits, or that they are simply not effective.
To help weigh up the arguments, we spoke to two experts in psychiatry with opposing views on the benefits of antidepressants.
Dr Joanna Moncrieff is well known for her critical views on the use of antidepressants. She lectures at UCL and chairs the Critical Psychiatry Network.
In her opinion, depression should not be seen as a chemical imbalance. In her experience, most people with depression suffer chiefly as a result of life experiences and the most important goal is to identify these in order to treat the condition.
Dr Moncrieff feels that antidepressants are too readily prescribed and does not believe they are effective, meaning some people may be taking medication they don’t need. She is concerned that many antidepressants have strong side effects including dulling of all emotional responses, sexual dysfunction, increased suicidal thoughts and aggressive behaviour in younger people.
She says most people are not fully weighing up these risks and that the clinical trial data is not strong enough to support their widespread use. In her opinion, antidepressants work like a psychoactive agent in that the medication changes the mood of the patient, but does not deal with the underlying cause.
For many, she says, the benefit to those who suffer from depression is mainly a placebo effect. When people are offered medication, they feel hope from the fact they are taking a pill, and that hope alone can be what makes them feel better, not any chemical in the medicine.
Dr Moncrieff argues that it is more important that people are given psychological coping mechanisms and that by prescribing antidepressants too readily, sufferers may not learn to develop the skills they need to cope.
Prof Sir Simon Wessely, argues that antidepressants play an important role in the treatment of people with mental illness. He is professor of psychological medicine King's College London and former President of the Royal College of Psychiatrists.
He feels that concerns that antidepressants are over-prescribed are misguided and that instead we should be asking whether everyone with depression who may need them, is getting them. Only 60% of depression sufferers receive any treatment at all, and Prof Wessely says if this was the treatment rate for other diseases such as cancer, society would be appalled. He firmly believes we need to remove the stigma surrounding seeking medical treatment for depression.
Many of those who criticise the use of antidepressants have highlighted the fact we don’t know how they work. However, Prof Wessely argues that this is the case with many medicines: we used antibiotics decades before understanding how they work, and the same is true for antidepressants.
He points to large bodies of evidence which show they are effective in the treatment of moderate to severe depression. Like most medicines, Prof Wessely acknowledges that antidepressants have side effects, but for most people these are mild. It is also important to note that when you are prescribed antidepressants, your doctor will discuss these with you and will monitor you for any problems you may suffer.
Prof Wessely argues that psychiatry should never rely on pharmaceutical or psychological treatments alone, but a combination of both. A good psychiatrist should look for causes of depression in people’s lives in addition to other factors, and offer all relevant treatment options.
What does the NHS say?
The NHS guidelines can be summarised as follows:
Mild depression; self-help interventions or cognitive behavioural therapy (CBT) will routinely be offered. Medication will generally only be offered if other interventions fail or dependent on your medical history.
Mild - Moderate depression; You may be prescribed medication or higher intensity CBT or specialist talking therapy.
Moderate – Severe Depression: A combination of medication and therapy will usually be advised
For young people there are strict prescribing guidelines for doctors, with only certain medications approved for use in the young. This is to use which takes into account of the increased risk to young people from some antidepressants.
