Do anti-depressants 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 I will do my best to answer.
On the surface, it seems relatively straightforward…” does medication help with depression?”
The pharmaceutical industry would have you believe that anti-depressants work. 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 taxpayer around £784,000 every day.
And, to put it simply, yes, they can help a little. But not for the reasons you might think. 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 fake pill. Research trials use a placebo to test whether drugs improve or improve problems.
What happens is you get two groups of people. One group will take the anti-depressant, and the other will take the placebo – a sugar pill. Only those in the group won’t know what they are taking.
Global media picked up Kirsch’s findings, and he was criticised greatly. But, the criticisms didn’t stand up. His findings were backed up by another leading Psychiatrist, Professor Walter Brown. (Davies, J. (2013).
We 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.”Professor Walter Brown
So, if they don’t work, why are we led to believe that they do?
As Dr James Davies argues in his book Cracked: Why Psychiatry is doing more harm than good, there are two main reasons.
- Psychiatry is dominated by a bio-medical model that suggests emotional pain is a disease.
- Pharmaceutical companies have exploited the opportunity to make billions of pounds worldwide.
Let’s take the first of these reasons, the bio-medical model in psychiatry.
The bio-medical model claims that people get depressed, anxious, addicted, have hallucinations, self-harm and commit suicide because of a chemical imbalance in the brain that is not normal. The trouble is that this belief isn’t based on scientific data.
How psychiatrists tend to make a diagnosis
Psychiatrists make a diagnosis using a guidebook 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 the 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 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 epinephrine. This is how they say SSRI antidepressant medication alleviates depression. And again, there is no evidence that people suffering from 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 of 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. Pharmaceutical companies fund nearly all medical trials investigating the effects of anti-depressant medication. And these companies have a vested interest in showing they work.
Not only does this lead you to question their motives, but numerous pharmaceutical companies have also been fined billions for concealing data that shows they don’t work 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, 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 can be small enough to make no 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 pharmaceutical companies to sway their prescribing habits. And what’s more, doctors have no legal requirement 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 has 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 looked like I am not an expert in that area, so it is best to discuss that with your GP. This seemed an appropriately neutral position to take.
But, more recently, I feel duty-bound to present the evidence after learning much more about the lack of proven scientific basis in the bio-medical model and the dubious behaviour of pharmaceuticals.
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 mainstream is just not accurate.
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, the first thing to do is 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 gentle movement?
These basic ways of caring for yourself often get abandoned when you suffer. But, it doesn’t work to avoid self-care. And it doesn’t work to avoid people even when this feels difficult.
The next step is to turn your attention to what is happening in your life. Your context heavily influences the way you feel.
- What stresses and strains are you under?
- Is there a problem in your relationship?
- Have you lost someone or something important?
- Are you concerned for your children’s health or well-being?
- Are you fighting to forget painful memories?
When you 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 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 work out a reduction plan. This will probably involve gradually reducing your dose over several weeks.
Another thing to consider is whether you will need any other support when you come off them. Anti-depressants have been shown to have a numbing effect. So, when you stop taking them, you may experience emotions that the anti-depressant has cut you off during the time you’ve taken 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, talking to a counsellor is also likely to be a valuable form of support.
I would like to thank Dr James Davies for his research and all the people who agreed to be interviewed. This has contributed to helping many people understand the science of mental health. I also wish to thank Dr Nic Hooper, whose writing has inspired my exploration of the medicalisation of human suffering.