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Abu Dhabi, UAESunday 23 September 2018

Antidepressants: The great debate

Antidepressant medication is taken by many around the world, but how effective is it really?

Tablet dosage box. Getty Images
Tablet dosage box. Getty Images

Every morning I reach above my kitchen sink and scrabble around for a blue box that’s separated into seven sections, each with a hinged lid. I tap the box onto the counter and out pop five tablets – two omega oil capsules to help ease my arthritis, a B12 supplement, a beta blocker for blood pressure (which I hope to soon stop taking) and a tiny, rectangular pill known as Zoloft, which is a brand name for sertraline – a selective serotonin reuptake inhibitor (SSRI). In other words, I take antidepressant medication.

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Read more: Antidepressants and the UAE

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And this causes me no shame whatsoever. After far too many years enduring far too much stress and emotional upheaval, I need a medication that puts me right, no different to taking muscle relaxants for a trapped nerve or applying a plaster to a cut on my finger. There are one or two side effects that I won’t go into here but, on balance, they’re worth it for the sense of calm I now experience. I’m back to being me again.

Professor Lewis Wolpert, an accomplished scientist with a loving family, went through a phase of constantly contemplating suicide – an experience he related in candid detail in his 1999 book, Malignant Sadness: The Anatomy of Depression. And “malignant sadness” is a brilliantly accurate descriptor for depression – it’s something that can eat away at you from inside while those around you are blissfully unaware. Yet it can, in the majority of cases, be removed – cut out – and those with it can resume a “normal” life, usually with the help of therapy, medication or, as has been my experience, a combination of the two. It’s just that, as with many medical woes, there’s no magic bullet. What works for me may not work for someone else.

Are antidepressant's efficient?

In recent weeks, debate has been sparked about the efficacy, or otherwise, of antidepressant medication. On February 21, The Lancet medical journal published a report that’s had the media and the world of medicine in something of a spin. It contained data analysed from 522 trials involving 116,477 people, and found that 21 widely used antidepressants had all proved more effective at reducing the symptoms of acute depression than placebos, although some drugs had proved more effective than others. While a few detractors are claiming medication is completely ineffective, there is plenty of concern about doctors’ apparent readiness to prescribe antidepressants instead of getting to the root cause of the depression suffered by patients.

“It’s almost come to the point when, if you’re not on some sort of antidepressant, people think there’s something wrong with you,” quips Andrew Bowen, a counsellor based in Dubai. “Elsewhere there is definitely a tendency for doctors to prescribe these meds as though they’re sticking plasters – get them down you, you’ll be all right. And the thing is, unless the professional prescribing these medications has an accurate picture of a patient’s mental and emotional history, as well as some background in their family’s experiences, they may well be dishing out terribly inappropriate medicines that do more harm than good.”

Indeed, patients put on certain drugs have been known to rapidly get worse, while doctors in various countries, many of whom are lured by lucrative commission payments from pharmaceutical companies, often glibly prescribe the meds that will help pay for this year’s winter holiday. That ­Lancet report, however, maintains that the problem is getting worse, stating that psychiatric disorders “account for 22.8 per cent of the global burden of ­diseases. The leading cause of this disability is ­depression, which has substantially increased since 1990, largely driven by population growth and ageing.” It adds that an ­estimated 350 million people are affected globally and that the cost to the American ­economy alone is more than US$210 billion (Dh771 bn) every year, through employee ­absenteeism, ­suicides and other undesirable results.

The side effects

And these results are now putting antidepressants under the critical spotlight. While the side effects I have experienced from taking sertraline are at worst an annoyance, it’s believed that 1 per cent of people taking these have severe ­reactions. The drugs are formulated to increase serotonin levels in the brain, which is supposed to improve symptoms of depression, at least for those with mild cases. But professor David Healy, of the psychiatric unit at the UK’s Bangor University, says that a quarter of all patients become more, not less anxious when taking the tablets. “The drugs can become the problem that they’re then used to treat,” he says.

Sarah Banham, a married 46-year-old Brit has had some very mixed results. “I’ve been on antidepressants twice now,” she says. The first time was eight years ago and her depression was related to post-­traumatic stress disorder (PTSD). “I largely ignored and hid from my PTSD for 10 years, but it became overwhelming and finally I did something about it, or rather I was forced to by the symptoms. It also coincided with being diagnosed with coeliac disease, which is renowned for having depression as a symptom.” Her doctor put her on an SSRI called Citalopram and she says she began to feel much better.

“However, once I faced the PTSD head-on and stopped eating gluten and corn, then [my depression] went away. I’m not sure how I could tell, but I could, and I slowly came off the tablets. The next time was in 2014, caused by anxiety and depression due to work pressures, which led to panic attacks.” She was again put on Citalopram, and says they helped with the depression but not the anxiety disorder, so she slowly came off them again. Interestingly, she discovered that the drugs had basically stripped her of any emotional feelings whatsoever. “I only realised this when the emotions came flooding back, but I wouldn’t say this was a negative as it was what I needed to get through the two periods.”

She changed tactics, went for counselling and says that even watching Gone with the Wind was a trigger for change. “It reminded me of the strong person I used to be,” she recalls, adding that regular exercise has also been a key to recovery. She is now training to be a debt counsellor and says there’s too much focus on self-love these days. “It’s thrown at us all the time and is just another thing we can’t live up to. I believe in thinking about others, giving back and helping the community are far better pursuits than self-exploration. You get a good feeling when you help people that you can’t get from helping yourself – if we all did that the world would be a better place.

The damage depression causes

What must never be underestimated is the damage that depression can do to individuals and families – it’s a killer and seeking professional treatment is essential. Like a malignant growth, it will not go away of its own accord and must be properly diagnosed and dealt with. Only careful monitoring of prescribed medication or treatment will ensure their usefulness (or otherwise), so that it can be adjusted to a patient’s personal circumstances.

When the 19th-century poet and writer Edgar Allan Poe died at the age of just 40, newspapers reported his untimely demise as being due to “brain congestion” yet, with the benefit of 159 years of scientific progress, it’s obvious to anyone that he was actually clinically depressed. Perhaps, had he been able to sit down with a psychologist or psychiatrist, he’d have been able to get the right kind of help and lived for another four decades. We have the tools at our disposal now, we just need to find the right ones.

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Read more:

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UAE experts' advice on how to deal with a break-up

A spoonful of medicine with a side of tech: why ‘swallowables’ are the next big thing

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