In the UK, 17% of the adult population take antidepressants, and in 6 years, prescriptions of antidepressants have increased by 35%. This increased usage of antidepressants is not limited to the UK. Globally, the use of antidepressants has always been increasing, and only spiked after the pandemic in 2019.
What is this substance so widely used on a global scale? Is it considered overprescribed to the point it does more harm than good?
What are they?
Antidepressants are medications (in the form of pills) that are mainly used to treat clinical depression in adults (mostly). They are also used for other mental health conditions and treating long-term pain.
Often prescribed by GPs and mental health professionals, they will constantly evaluate the effectiveness and benefits of the medication to the patient: if the symptoms do not show improvements at all, the medication will be slowly withdrawn; if the results are not as effective, a smaller increase of dosage will be increased
Why do you think they are often slowly given and withdrawn..?
How antidepressants work
To understand how antidepressants work, let’s take a look at the most commonly prescribed type of antidepressant: selective serotonin reuptake inhibitors (SSRIs).
Serotonin is a neurotransmitter often known as the ‘mood stabiliser’ or ‘happy hormone’, and it helps transmit chemical signals between neurons. As the name suggests, SSRIs relieve depression by inhibiting (blocking) the reuptake of serotonin into neurons to increase the serotonin levels in the brain, helping stabilise moods and hence alleviating symptoms of depression.
Other antidepressants also function similarly; in general, antidepressants increase levels of neurotransmitters, such as noradrenaline, to improve one’s mood.
Why use them?
1. Some evidence shows improvement in symptoms:
Antidepressants can help improve the mood of severe symptoms, this in turn, improves the motivation and attitude of the patients, allowing other therapies such as CBT (cognitive behavioral therapy, which requires talking and motivation) to take effect, as well as counter-dangerous thoughts such as suicide
(optional) Royal college of psychiatrists reports that 50-65% of patients (with moderate to severe symptoms of depression) showed improvements after using antidepressants- compared to 25-30% effectiveness of patients with similar symptoms using a placebo.
2. Fast effectiveness
They take effect in relatively short periods of time (around 1 or 2 weeks) - by working on the nervous system. Compared to ‘talking’ therapies such as CBT (5-20 weeks to take effect), the progressive effectiveness approach may not be as beneficial in certain circumstances, such as severe irrational thinking and beliefs.
Unfortunately, antidepressants cause side effects, which differ from antidepressant to antidepressant. Common side effects include:
Heart rhythm problems (arrhythmia)
Antidepressants may even lead to complications such as:
Serotonin syndrome (too much serotonin, causing shivering and diarrhoea, and if severe, seizures and unconsciousness)
Hyponatraemia (severe fall in sodium levels, causing muscle pain and confusion, and if severe, disorientation and agitation)
Striking the Balance - How they are used
Large dosage of medication/ drug may lead to:
1) Dependence on the drug - as it removes negative feelings to give positive feelings meaning patients may be ‘addicted’ to the antidepressants! This process is called negative reinforcement
2) Withdrawal symptoms- when the patient feels physical symptoms by ‘taking away' the drug or dependent substance. Some withdrawal symptoms include restlessness, insomnia, unsteadiness, sweating, stomach pain, and feeling anxious and confused
3) Severe side effects linked to the excessively fast increase of neurotransmitters in the synapses.
Therefore, treatments will always start slowly and end slowly! Other kinds of therapy are also recommended (such as CBT) to assist medication and to help balance and improve.
To treat depression (and other mental health conditions), other treatments and therapies can be used alternatively, or paired with the usage of antidepressants, for example:
Cognitive behavioral therapy (CBT): A form of talk therapy, where the therapist assists the patient in understanding their thoughts and behaviors, and comes up with practical methods to overcome their mental health condition
Lithium: Lithium may help reduce abnormal brain activity, manic episodes, and suicidal feelings, but often accompanied by side effects like shaking
Electroconvulsive therapy (ECT): An electric current flows through the brain via electrodes; studies suggest this may help reduce connections in an area of the brain linked to depression
Should we use them?
Other than the strengths and weaknesses of antidepressants based on their use and side effects, antidepressants may not be suitable for everyone. Sometimes we lack human interactions that make us more isolated and vulnerable in our own way, thus leading to depression. When we lack these social interactions, talking therapy, including counselling, interpersonal therapy or others may be more beneficial!
Choose the correct and most suitable therapy for you! You should choose the treatment that works best for you - there is no perfect ailment except your own understanding!
Open Question: Do you think antidepressants can ‘cure’ depression entirely? Does it change our ‘thoughts’?