There has been a lot of debate recently, following the publication of Johann Hari’s new book, about what role medication plays in helping people recover from depression.
Few people would argue that a long-term dependency on antidepressants is a good thing. Numerous studies have shown that withdrawal symptoms can be very severe and become a major mental health risk factor in themselves. Our clients at Fernwood report that whilst antidepressants can provide a safety net during a particularly severe episode, in general they tend to numb us to the experiences of everyday life--both positive and negative.
So, if we accept that generally it would be preferable not to rely on antidepressants for too long, the next decision is when to take them and for what period.
To provide some context, it is important to understand how antidepressants are prescribed in the UK. Generally, antidepressants are prescribed by GPs, and in the minority of cases--by psychiatrists. In 2016, there was a record number of antidepressants prescribed through the NHS. From our experience of interacting with GPs from our local area, we have observed the following. GPs only have 10 minutes to see each patient. In that time they need to assess their concerns, develop an appropriate treatment plan, prescribe medication or provide a referral etc. It is a very limited time frame to properly assess risk level for someone presenting with low mood and, considering a long waiting list for NHS talking therapy, antidepressants are frequently the only practically available option.
With this in mind, it would probably not be an overstatement to say that the majority of people who ask their GPs for antidepressants will get them, which makes it even more important that we try to make an informed choice.
Are antidepressants clinically effective? This is a very big question. It is probably best addressed in the context of “compared to what”. Compared to doing nothing? Yes. Compared to placebo? Yes (at least for short term acute depression in adults). Compared to talking therapy? And this is where it gets interesting. Most studies find no statistically significant difference in recovery for antidepressants versus talking therapy. However, these studies tend to measure recovery straight after treatment, rather than look at the longer-term outcomes, i.e. whether progress has actually been maintained.
The NICE (National Institute of Clinical Excellence) recommendation is that both medication and talking therapy should be made available to clients with low mood and anxiety, and it is a personal choice which one you would prefer. However, the two approaches are very different. The way we address the problem is indicative of the way we view the problem. So if we take medication, naturally this means that we think the issue is the chemical imbalance in the brain. If we choose to talk, we acknowledge that our life’s context must be taken into account.
In our experience, our clients’ concerns tend to stem from external circumstances (whether past or present), combined with a way that they react and deal with those circumstances--the two often reinforcing each other through time. Each person has a unique and valuable story, which must be respected and untangled with great care to discover a way forward.
We hope our clients and readers feel empowered to make a mindful and informed choice when it comes to medication, therapy or both.
Fernwood Clinic Team
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