That Age Old Anti-Depressant Argument

Pills don't fix everything. But for many people, it's a start.

In the Guardian today, Ranjana Srivastava raises the point that prescribing anti-depressants is often an easy way out for doctors:

"...signing a prescription for an antidepressant would take merely the flourish of my pen, and constitute decisive action. You could say that in this moment, the promise of a solution provides a glimmer of hope for the patient and therefore, a temptation for the doctor." 

It's an interesting point. And not one without merit. Last year, Peter Gotzsche claimed:

"...more than 53m(illion) prescriptions for antidepressants were issued in 2013 in England alone. This is almost the equivalent of one for every man, woman and child and constitutes a 92% increase since 2003."

It's a shocking statistic. But it's made to shock. Despite what he's saying, 1 for every man, woman and child actually doesn't work out at all that much when you consider people on anti-depressants take them DAILY and often have more than one drug at any given time.

But Gotzsche isolates the issue of medication. He views it as an industry (which is it of course), and one in which doctors want to support without consideration of what is best for their patient. He cites three main reasons for the rise in mental health related medication use:

"First, the definitions of psychiatric disorders are so vague that many healthy people can be diagnosed inappropriately. Second, some of the psychiatrists who wrote the diagnostic manuals were on the industry's payroll, and this may have also led to significant diagnostic inflation. Third, the companies' behaviour has been worse in psychiatry than in any other area of medicine, with billion-dollar fines paid for the illegal marketing of psychiatric drugs for non-approved uses." 

However, you cannot isolate the incident of rising anti-depressant prescriptions from the changes in overall mental health treatment that have been occurring. Treatment across all platforms is inter-linked. Increase in medication use is also echoed in the increase in those attending other therapies.

Counselling waiting lists have increased over the same period. See: Irish Examiner, IrishHealth.com, Belfast Telegraph

Previously the main barrier to seeking help was stigma. See: counselling.psych.iastate.edu

Stigma is starting to break down and people are seeking help for their problems on this side of the Atlantic for the first time. Of course the usage of anti-depressants is also going to increase.

Why are so many people mentally disturbed?

Gotzshce doesn't believe that an increase in mental ill-health diagnoses can be put down to a decrease in stigma.

"It is hard to believe that so many people have become mentally disturbed and that these prescription increases reflect a genuine need, so we need to look for other explanations."

Firstly, I don't consider myself 'mentally disturbed' thank you very much.
And I also refuse to believe that the levels of prescribed medication in the past is a reflection of how many people were actually experiencing a mental illness. Again, stigma comes up a huge preventative issue when it comes to people seeking help and treatment.
But what does represent a real genuine need for medication according to Gotzshce?
Inability to sleep? Loss of appetite? Inability to concentrate? Thoughts of suicide or self-harm? Acts of suicide or self-harm?
He doesn't say.

This shows a real lack of understanding about how the mind works. It's something that is prevalent in all discourses as documented in my previous post - 'The Problem With Current Mental Illness Terminology'. And this comes from Doctors and Clinicians too. I have no doubt that some doctors are too quick to prescribe anti-depressants. I am also confident that others refuse to believe anti-depressants have any positive effects on mental illness. Doctors in this case often won't treat mental health with medication and try to ween patients off them as soon as they can.

I know because I've experienced both of these types of medical professionals.


Risks vs Benefits of taking Anti-Depressants

Gotzshce's main argument against the use of anti-depressants is that there are risks and side-effects.

 "The way we currently use psychiatric drugs is causing more harm than good." 

Like with many types of treatment there are side-effects. We expect a patient in radiotherapy to experience tiredness, loss of hair and painful skin. Fighting back against an illness is exhausting, and it comes with risks, of course it does.
But Gotzshce refuses to acknowledge that there are also benefits. Patients often experience increases in appetite, better moods, return to a normal sleeping pattern.
The results of anti-depressants are also often difficult to analyse - Which symptoms are caused by the illness, and which by the drugs? If one combination of medicine hasn't had any effect, there are many more to try.
And due to a lack of understanding as to what causes mental illnesses, treatment is always going to be difficult and have varied effects.

Withdrawal 

A recurring issue with anyone who has ever been on anti-depressants is whether to get off them or not. It's a decision that is often attached to stigma - 'I don't want to be on anti-depressants for the rest of my life' is a phrase issued by so many who experience mental illness. There is a very evident fear of dependency prevalent in the mental health community. Many people with mental health problems have overcome them without the use of medication, so why should you be one who has to remain on drugs?
But would we say the same thing about medication for heart conditions? Blood pressure?
Withdrawal also has to occur gradually over time. It's a risky process for those on medication:

"Withdrawal symptoms are often misdiagnosed as a return of the disease or the start of a new one, for which drugs are then prescribed. Over time, this leads to an increase in the number of drug-dependent, long-term users." 

In this I have to agree with Gotzshce. The fear of what happens without medication often outweighs the fear of dependency. Especially among doctors. But healthcare professionals also fail to agree on whether one can become dependent on medication or not.
I have been given varied advice from 'But you'll get addicted' to 'Dependency isn't a risk'. With so many differing opinions, finding the 'right' advice for those with a mental illness is hard to come by.

“Doctor, is there a pill for this?” 

I don't believe that a pill will fix all your problems.
But it is also naive and dangerous to ignore the many people who have had successful results with anti-depressants.
Mental health awareness in Ireland has also been shifting the focus onto treatment by a combination of things in recent years; talking therapy, healthy eating, exercise, CBT. Using multiple techniques have been more successful than using any one in isolation.
Not for any illness is there 'one cure fits all' approach.

As Ranjana Srivastava says, when a patient asks “Doctor, is there a pill for this?” sometimes the truthful answer must be given: “Actually, there isn’t.”