Comment

Ian Hulatt: Melancholy disputes over effectiveness of antidepressants

A huge review of the evidence has found antidepressants are more effective than placebos. But what works and what doesn’t in the treatment of depression is far from straightforward

A huge review of the evidence has found antidepressants are more effective than placebos. But what works and what doesn’t in the treatment of depression is far from straightforward


Capsules of fluoxetine, known by the brand name Prozac, used to treat depression
and anxiety disorders. Picture: Science Photo Library

A disposition to melancholy, a disturbance in the humours or a biological disturbance remedied by a chemical preparation. The history of depression is almost a microcosm of societal and scientific approaches to mental distress.

While our colleagues in physical medicine never have to argue for the existence of the diseases they treat, life is not so simple in the world of depression.

There are those who see it as a rational response to overwhelmingly sad situations, or even a rational response to the very nature of the precarious self that we embody. There are those for whom the concept of depression is exploited by ‘big pharma’ in collusion with professionals who gain from prescribing their products.

Sense of suffering

All of this pales into insignificance when one considers that people with depression have a sense of real suffering and, like many other conditions, it may prove fatal if untreated.

In February the Lancet published a meta-analysis of the effectiveness of 21 common antidepressants. Some drugs were more effective than others, but all of them were more effective than placebos, settling a long-running controversy, according to the study’s lead author.

I suspect questions will continue to be asked as those with various – and opposing – viewpoints examine the Lancet paper closely to abstract information to support their view.

Validate and respect

The fact that antidepressants are more effective than placebos is of course reassuring, but before the prescription pad is reached for there are other ways to alleviate the milder forms of depression that should be considered. The evidence for psychological interventions is equally compelling, if somewhat scarcer in practice.

So where does that leave you and I as we attempt to support those who have commenced treatment with antidepressants?

Perhaps our first responsibility is to steadily assist our clients to navigate carefully through the competing views on the effectiveness of drug treatments. But we also need to offer a perspective that values their personal experience about what works for them and how. It is essential that we validate and respect the experience of those we help.


Ian Hulatt is consultant editor of Mental Health Practice

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