Do antidepressants work?

I wish this was a simple question to answer. What makes it difficult is the endless misinformation and controversy.

But, it is an important question, which I am going to do my best to answer.

On the surface, it seems fairly straightforward…”does medication help with depression?”

The pharmaceutical industry would have you believe that anti-depressants work. In fact, many Doctors believe anti-depressants help with depression. So much so that in 2012, the NHS issued 50 million prescriptions for anti-depressant medications. This costs the British tax payer around £784,000 every day.

And, to put it simply, yes, they can help a little.  But, not for the reasons you might think.  In fact, anti-depressants only help because of something called the placebo-effect.

And, in reality,

between ’85 to 90% of people being prescribed anti-depressants are not getting any clinically meaningful benefit from the drug itself’ (Kirsch, I. 2008)

So, what is the placebo effect?

A Placebo is a pill that is fake. Research trials use placebo to test whether drugs actually make problems better or worse.

What happens is you get two groups of people. One group will take the anti-depressant and the other group will take the placebo – a sugar pill. Only, those in the group won’t know what they are taking.

Now what Kirsch found in his studies was that anti-depressants worked no better than sugar pills. The only exception was with people who were severely depressed. And, only then did they conclude that it may have minor benefits.

Kirsch’s findings were picked up by media across the globe and he was criticised a lot. But, the criticisms didn’t stand up. His findings were even backed up by another leading Psychiatrist Professor Walter Brown. (Davies, J. (2013).

We pretty much found the same thing as Kirsch…for mildly and moderately depressed patients, our results confirm that anti-depressants offer no advantage over placebos, alternative therapies, or even moderate exercise.”

So, if they don’t work, why are we led to believe that they do?

Well, as Dr James Davies argues in his book ‘Cracked: Why Psychiatry is doing more harm than good‘, there are two main reasons.

1. Psychiatry is dominated by a bio-medical model that suggests emotional pain is a disease

2. Pharmaceutical companies have exploited the opportunity to make billions of pounds across the world

Let’s take the first of these reasons, the bio-medical model in psychiatry.

The bio-medical model claims that the reasons people get depressed, anxious, addicted, have hallucinations, self-harm and commit suicide is because there is a chemical imbalance in the brain that is not normal. The trouble is that this belief isn’t based on any actual scientific data.

How psychiatrists tends to make a diagnosis

Psychiatrists make a diagnosis using a guide book called DSM.  Since its first edition in 1952, there have now been five revisions. The most recent was in 2013. And the number of possible things you could have wrong with you has dramatically increased.

And the way most psychiatrists use this book is to match a person’s reported experience with the list of diagnoses laid out in DSM. It is down to the Psychiatrist to accurately diagnose. The trouble is that psychiatrists tend to give different diagnoses to the same person at least 1/3 of the time.  So, it is subjective and highly inconsistent (Rosenhan, D L, 1975).

The other important point is that unlike any other form of medicine, there are no biological markers to prove the existence of mental health problems. You can’t do a blood or a urine test to prove depression or anxiety disorders exist.

Pharmaceuticals also claim that anti-depressants work because they re-balance neurotransmitter brain chemicals like serotonin and epinepherine. This is how they say SSRI antidepressant medication alleviates depression. And again, there is no evidence that people who are suffering with depression have an imbalance in these neurotransmitters.  What’s more, is that there are no guidelines defining optimum balance.

Shocked?  I certainly was.  The sum of it, is that there is just no evidence to prove that emotional pain is any way shape or form a medical problem. And there is no evidence that depression is a problem that requires medication as an intervention.

The financial stronghold of the Pharmaceutical Industry

The second reason so many doctors believe medication works is that they are told so by the pharmaceutical industry. In fact, nearly all medical trials investigating the effects of anti-depressant medication are funded by pharmacy companies.  And, these companies have a vested interest in showing they work.

Not only does this lead you to question their motives, numerous pharmacy companies have been fined billions for concealing data that shows they don’t work that well.

But the problem also rests with the authorities that approve medications to be sold. The FDA in the US and the MHRA in the UK require a drug company to show in just two clinical trials that their antidepressant is more effective than a placebo. If this can be shown, then no matter how many negative studies there have been, the drug will be approved for public use’ (Davies, 2013).

Davies also points out the trial doesn’t even have to show that the drug is clinically superior. It merely needs to show a statistical difference, which in reality can be small enough to make no actual difference to the person’s life.

Conflicts of Interest

You might think that one form of protection against the commercial interest of pharmaceutical companies would be the psychiatric profession.  But, as Davies shows us, Psychiatrists and GPs routinely receive financial incentives from pharmacy companies in order to sway their prescribing habits. And, what’s more is that there is no legal requirement for doctors to declare any additional earnings they receive from Big Pharma.

Given the findings that antidepressants are no better than a sugar pill and that Big Pharma have shown dishonesty in effectiveness studies, it is wise to be suspicious of their claims.

The position of this article is clear – BEWARE!

This is somewhat different from the position I used to take when asked this question by clients in the therapy room. Previously my response has looked something like I am not an expert in that area and so it is best to discuss that with your GP.  This seemed an appropriately neutral position to take.

But, more recently, after having learned much more about the lack of proven scientific basis in the bio-medical model and the dubious behaviour of pharmaceuticals, I feel duty-bound to present the evidence.

You may argue that this is not neutral to do so. But, I would argue that by not doing so I am allowing a person to continue under the impression that depression is a mental illness with proven biological markers for which antidepressant medication offers a ‘cure’.  This information presented by the main stream is just not accurate.

Even the NHS UK website states that “most people benefit from taking antidepressants to some degree.” When the data doesn’t back this up.

What should you do instead?

If you are struggling with low mood and debilitating anxiety, then the first thing to do is to check in with how well you are taking care of yourself.

• Are you eating well every day?
• Are you getting some exercise and staying active?
• Are you talking to people, connecting with them and letting others know you are struggling?
• Are you listening to your body and responding to what it needs e.g. rest, water or some gentle movement?

These basic ways of taking care of yourself often get abandoned when you are suffering. But, it doesn’t work to avoid self-care. And it doesn’t work to avoid people even when this feels so difficult to do.

The next step is to turn your attention to what is happening in your life. They way you feel is heavily influenced by your context.

• What stresses and strains are you under?
• Is there a problem in your relationship?
• Have you lost someone or something important?
• Are you really concerned for your children’s health or well-being?
• Are you fighting to forget painful memories?

When you start to look at what is happening in your life, you can start to understand you have valid reasons for why you feel like you do. Context is everything.

And finally, you may want to seek out professional intervention from a suitably qualified and accredited counsellor or psychotherapist. Whilst therapy is not the perfect solution i.e. not everyone benefits from therapy, many people do.

What should you do if you are already taking anti-depressants?

One final question I want to address is “what should you do if you are already taking anti-depressants?”  I appreciate that you may wish to stop taking them after reading this article. My advice is to be cautious and to take it slow. You can experience side-effects if you suddenly stop taking them. These might include high anxiety, dizziness, headaches and feeling sick.

If you decide you want to come off them, then it is sensible to discuss this with your prescriber and to work out a reduction plan. This will probably involve gradually reducing your dose over several weeks.

Another thing to consider is will you need any other support when you come off them? Anti-depressants have been shown to have a numbing affect. So, when you stop taking them, you may start to experience emotions that the anti-depressant has cut you off from during the time you’ve been taking it.

It would be wise to consider whether you are ready for this. Feelings aren’t dangerous, but they can be painful. You may need to ensure you are taking care of yourself and you have a support network around you. In addition, if you feel you would benefit from exploring events from your past, then talking to a counsellor is also likely to be a useful form of support.

I would like to thank Dr James Davies for his research as well as all the people who agreed to be interviewed. This has been a valuable contribution to helping many people understand the science around mental health. I also wish to thank Dr Nic Hooper who’s writing has inspired my own exploration of the medicalisation of human suffering.

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