Denni, the reports on antidepressants must be understood in many different contexts. It's quite true that many people who are given them should not be and it's also quite true to say that big pharma pushes them, and they really shouldn't.
The big problem, though, is the chronic lack of interest in mental health issues by government and society at large. In fact, I'd say depression, although far better understood than in the past, is one of the last great taboos we have. Certainly in the UK.
However, antidepressants are extremely valuable for those that genuinely do need them. Speak to any front-line medical professional and they will tell you the same thing: When someone presents to them with clinical depression and is given the right antidepressant, they are 9/10 times extremely effective (in the short term).
Clearly the major caveats here are, firstly, getting the right drug which, at the moment, can only be done on a trial and error basis and, secondly, the consideration of the proportion that are not helped by any of these drugs.
Then there is the problem of volition. This can occur in the period between starting the drug and the drug having its full effects: Simply put, before the drug has its mood-improving effects, it often causes the patient to recover their energy, both physical and mental.
This is potentially very dangerous for someone who has been deeply depressed and has had suicidal thoughts, but hasn't taken any action because of the lack of motivation associated with depression. Some patients have taken their lives in this period.
It is a tough one. In my opinion, the evaluation of depressed patients should be very thorough - preferably carried out by a clinical psychologist or a psychiatrist. Certainly, if a patient expresses any suicidal thoughts to their primary healthcare provider, this should happen. Those who are deemed at risk should be hospitalized until they are seen to be responding to the medication.
In the UK, there is simply not enough money to do this. Far too few clinical psychologists are being trained (
DH Cohen: CBT is inadequate and administered by the unqualified | Comment is free | guardian.co.uk) and inappropriate treatment is often given.
The most important factor of all is what is done when the patient is responding to the drugs. Often they will simply be sent off and re-evaluated on subsequent prescription re-writes but never referred for talk-therapy.
Some people may well just need the one course of drugs to help overcome a difficult time in their lives, but others (for whom the majority of prescriptions are written), will likely end up being off and on the drugs for years. These are the people with deep-seated issues involving low self-esteem, trauma and neurological deficiencies.
Evaluating the effectiveness of ADs comes down to how we define success in treating mental illness. If a single illness episode is overcome but the underlying issues are left untreated is that a successful outcome?
Yes and no, I'd say!
