Demystifying Depression/The Controversy about Antidepressants

The Controversy about Antidepressants
This is largely country-dependent: in some countries their use is widespread and generates little discussion; in others, many factors contribute to making them practically taboo words. The country where I live, the Netherlands, tends towards the taboo end of the spectrum. The reason has a lot to do with the prevalent (and backwards if you ask me) Calvinist mentality. I know that in other places, such as most of North America and Southern Europe they are much more readily accepted. Your mileage may vary.

The controversy is typically framed in the following ways: doctors nowadays over-prescribe antidepressants, instead of following the psychotherapy route; antidepressants are just a ploy from the evil pharmaceutical multinationals; our societies are drifting towards a "Brave New World" scenario where drugs are used to keep the populace happy and unable to rebel. Well, my personal opinion is that there is some substance to some of these worries, but they are largely exaggerated and fail to acknowledge one very important fact: antidepressants are very effective in treating clinical depression. This is not a matter of opinion: it has been demonstrated in several double-blind clinical trials.

First, on the issue of over-prescription. I would say that they are both over-prescribed and under-prescribed. The problem is that most doctors do not understand depression well, and will prescribe drugs to people whose brains are healthy, and fail to provide them to people who could actually benefit from them. Take people who are mourning, for example. In most cases, these people do not have a depression. Grief is something perfectly normal, and its onset is all too sudden to cause a depression (remember that a depression typically takes years to develop). Likewise, consider giving antidepressants to very young people: the brain of a child or even a teenager has such a fantastic ability to repair itself that it takes quite a pounding for a depression to develop. In these cases, antidepressants and all their unavoidable side effects are more likely to hurt than to help. On the other hand, there are people who have minor problems with stress and anxiety, or whose blood pressure is above normal for no apparent reason. They are often simply told that they should watch out for salt in their diets, or to take up yoga or meditation. This advice might help, but only to a certain degree. I suspect that a course of an antidepressant would have a stronger and more lasting effect.

Moving on to the subject of side-effects. Modern antidepressants are generally well-tolerated and safe to use. They do have side-effects, which depending on the drug and the person can be significant enough that people discontinue taking the medication. However, this is yet another issue where proper handling by a competent professional will make a huge difference. What one often finds is that people are given the wrong drug for their case. Imagine for example an overweight patient being given an antidepressant which increases appetite, or someone who has a satisfactory sex life and is given a drug which upsets their libido. What is required is matching the profile of the patient with the expected side-effects of the drug. Granted, there is plenty of variation among individuals, but the overall pattern is still strong enough that we can categorically say what will be the most likely side-effects of a given antidepressant. A straightforward discussion with a good professional will go a long way towards finding a drug tuned to your particular case, thus minimising the negative side-effects and decreasing the chances of premature discontinuation.

Finally on to the subject of psychotherapy. As someone who had a depression, I can assure you that there is nothing more patronising and irritating than people who bring up the "psychological help". A depressed person will definitely need professional help, but mostly for a proper explanation of the problem, to learn relaxation techniques, to know how to listen to their bodies, and to be coached in the lifestyle changes required for giving their brains a chance to recover. Once they are recovered, perhaps some therapy might be needed to make sure that whatever behavioural patterns which contributed to the development of the illness will not recur. However, and I cannot stress this enough, therapy is not a substitute for medication, and "psychological help" is a misunderstanding.