Antidepressants – are they effective?

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This week a new research study about antidepressants has been published which has been hitting the headlines.

 The study carried out by a team of researchers from the University of Hull analysed all clinical trails which have taken place for the following four antidepressants: fluoxetine, venlafaxine, nefazodone and paroxetine. All these antidepressants are types of SSRIs (selective serotonin re-uptakers). They are said to work by stopping receptors from taking up serotonin, increasing the amount of serotonin and therefore improving our mood.

All antidepressants have to go through clinical trials against a placebo (a dummy pill). The medicine has to demonstrate that it is more effective than a placebo before it can get a license to be used. The researchers looked at all the clinical trials for these antidepressants; some of these trials had been published and were already in the public domain. Some had not been published and the researchers used the Freedom of Information Act to get access to these studies.

After analysing all the different trials, the researchers concluded that antidepressants did not produce clinically significant improvements in mild, moderate and severe depression. Significant improvements were only found in the most severely depressed patients and this was said to be due to these patients been less receptive to placebo, i.e  they found the dummy pill less effective not the antidepressant more effective.

This raises lots of questions about antidepressant use, especially as the number of prescriptions have soared in recent years. Very briefly, these issues tend to focus around:

• GPs could be prescribing antidepressants too easily. However, GPs argue that due to the lack of ‘talking’ therapies and the long waiting lists, prescribing antidepressants is the main option. GPs also argue that they feel some patients need to take antidepressants in order to be receptive to psychological therapy.
• Are more people are getting depression? Again, experts in charities might argue that people are just more aware of depression now and are more likely to seek help – instead of opting for the English ’stiff upper lip’ response.

However, this also raises some different issues for agoraphobics and sufferers of anxiety disorders. In all this debate about the use of antidepressants, people seem to forget that they are not just used for depression. This particular study was looking at depressed patients yet antidepressants are also prescribed for panic disorder, agoraphobia, social phobia, OCD, anorexia and PMT. There are very few studies looking at the use of antidepresants for panic disorder (with or without agoraphobia).

 One such study on panic disorder  did take place though in 2006. This review of various studies compared the effectiveness of being treated with both psychotherapy and antidepressants compared to being just treated with either psychotherapy or antidepressants on their own. The results showed that the use of psychotherapy and antidepressants together was the most effective. However, two years later 60 per cent of patients had not fully overcome the condition with any of the treatment options.

So where does this leave agoraphobics and anxiety sufferers? At the end of the day, most of us just want to feel better and we’re not too bothered about how we get better, just as long as we do. If we take an antidepressant and this helps us, does it matter that it is down to the placebo effect? If I take antidepressants, do not think they will work and then to my surprise find they have helped, is this down to the placebo effect?

There isn’t one answer for everyone. Some people find antidepressants helpful, some don’t. Some people have a few mild side-effects to start off with and others don’t. My personal advice is: If you haven’t tried antidepressanst before, if you’re housebound or suffering from anxiety and are very unhappy about your situation then they are worth a try. There are a few rules I would suggest when taking antidepressants:

• Ask for psychological therapy as well – cognitive behavioural therapy is best, or counselling if waiting lists are too long.
• Don’t get too worried about side-effects and do not keep reading the leaflet which comes with the medication! Most side-effects are mild and go away after a couple of weeks.
• If your side effects aren’t mild then change to a different antidepressant. You could try and different brand and have few side-effects, it is worth trying another brand.
• Antidepressants take a while to work – they are not instant. You need to take them for at least a month before seeing any sort of improvement and it can often take longer than this for you to notice an improvement. Any side-effects should wear off in the first couple of weeks, it is important to stick out the treatment and get through this period.
• Have regular check-ups with your GP and discuss any concerns you have about side-effects with them.
• Do not suddenly stop your medication. Speak to your GP first.

I’d be interested in hearing your views about antidepressants. Did they help you at all?

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