What are the facts? A new paper submitted to the journal Public
Library of Science Medicine by Hull University researchers has concluded
that the commonly used antidepressant drugs called selective serotonin
reuptake inhibitors (SSRIs) provide little benefit for most people with mild
and moderate depression, and actively help only a small group of the most
severely depressed. Last year a record 16 million prescriptions were issued
in Britain, a 10 per cent rise on the year before. The Hull researchers
studied 47 separate clinical trials, published and unpublished, and say that
for some patients, these Prozac-type drugs are no more effective than a
placebo sugar pill.
So are the drugs useless? The new study contradicts the detail of many
previous studies and suggests that the drugs fail more people than other
research has shown. But taken together with the previous studies, the weight
of evidence still points to the fact that SSRIs can offer a chemical lift
that enables some people with moderate to severe depression to take
sustainable steps towards curing or alleviating their condition. Sir Richard
Peto, the Oxford University professor of medical statistics and
epidemiology, maintains that, despite the Hull study’s conclusions: “The
trial data show that SSRIs are safe and moderately effective, and for some
people they are very effective. In a two-year trial we did of people who had
a major depressive episode, taking antidepressants for two years, only a
quarter had their illness recur, compared with half who took placebos.”
I’m still worried. Can I stop taking the drugs? The Royal College
of Psychiatrists (RCP) is urging people on antidepressants not to
discontinue them without consulting a doctor. Stopping treatment suddenly
can have adverse consequences. In the US, the adverse symptoms are called
“antidepressant withdrawal syndrome” and can involve flu-like symptoms,
insomnia, nausea, imbalance, sensory disturbances, hyper-arousal and
electric-shock sensations. Doctors recommend gradually tapering doses before
quitting.
How long should I keep taking the drugs? The RCP recommends that
patients take antidepressants for six months after they start to feel
better. Professor Steve Field, the chair of the Royal College of General
Practitioners, says that patients on SSRIs should have regular reviews with
their GPs, and “should ask upfront about treatments that may work in
addition to the drugs or instead of them”.
So how should I respond to the new study? Treat it as a wake-up call.
For most people, these drugs are not for long-term maintenance, they are
there to bolster while you make adjustments to your life and thinking
habits, to bring sustainable benefits. Government policy says that you
should not be prescribed SSRIs without other forms of help. Guidelines from
the National Institute for Health and Clinical Excellence (NICE) state that
“talking therapies” rather than drugs are the best first-line therapy for
patients with mild depression, and that therapy for patients who have
moderate-to-severe depression should be a combination of talking therapy and
antidepressants.
Does talking therapy mean 20 minutes with the practice nurse?
Hopefully, it should involve much more than that. Trained therapists should,
in theory, be available to you. Unfortunately, resource shortages mean that
the availability of talking therapies on the NHS varies greatly across the
country. Alan Johnston, the Health Secretary, has announced plans to train
3,600 therapists in the next three years, mostly to provide cognitive
behavioural therapy (CBT). Evidence shows that this can help people who have
developed bad thinking and behavioural habits by teaching them healthier
approaches.
What if my GP cannot give me access to a trained therapist? There may
be a virtual option. In 2006, NICE recommended an online CBT programme,
Beating the Blues, for all people with mild or moderate depression. The
programme, developed by psychiatrists at King’s College London, consists of
eight 50-minute interactive CBT sessions. Sessions are held at the patient’s
GP surgery and are available at more than 300 NHS sites.
What else can I do without the doctor? The simple answer is to help
your body to lift your morale by getting healthier with diet and exercise,
and by cutting your intake of alcohol and “recreational” drugs, which are
depressants when taken regularly to excess. The difficult bit is making
changes at a time when even getting out of bed can feel impossible. Being in
bad shape can prompt depression: it’s increasingly linked to poor
cardiovascular health, for example. And simple good, fresh food contains a
battery of morale-lifting nutrients. Increasing your intake of omega3 fats
found in oily fish may help. Recent research has found that lower levels of
omega3 in the body appear to increase the risk of depression.
Even in my happier moods, I hate the idea of gyms Try brisk walking in
the open air. Exposure to Mother Nature is a well-proven antidepressant.
Take your partner or a pal along; it’s an excellent opportunity to talk
about problems without feeling stuck in some dismal “therapeutic” setting.
Getting outside increases your exposure to natural daylight. Lack of it can
cause the depressive condition, seasonal affective disorder. If you suffer
from winter blues, you may find a light box helpful.
Any herbal alternatives? Hypericum, made from the herb St John’s wort,
is sold in health shops, but its usefulness is moot. A review of 37 previous
studies by the highly respected Cochrane Database in 2005 found that:
“Evidence regarding hypericum extracts is inconsistent and confusing.”
Might complementary therapies work? Meditation, in the form of
Transcendental Meditation, has been found to work in a number of trials. Not
all of them were independent, though. Other therapies have not yet got
sufficient scientific research backing. With acupuncture, for example, a
2005 Cochrane study says: “There is insufficient evidence to determine its
efficacy compared with medication in the management of depression.”
Why can’t I just find a straightforward cure? Well, that’s life
and depression is often part of it. About one in four of us will get
clinically depressed at some time. The term “depression” covers a wide
spectrum of distress and a huge variety of causes and effects. This makes
treatment complicated. Often, though, depression will resolve itself within
weeks, whether treated or not. The RCP says that without treatment, most
depressions get better after about eight months.
For more help, contact Mind, the mental health charity: 0845 7660163; mind.org.uk
Read I Had a Black Dog at timesonline.co.uk/health
Depression by numbers
54 million the number of people who use Prozac worldwide
33% of all sick days taken in the UK are caused by depression and
anxiety
£9 million a year is the cost of depression to the UK in
treatment, benefits and lost revenue
SOURCE: TIMES DATABASE
