Antidepressants could be counted as one of the miracle successes of modern medicine, globally earning drug companies more than £12 billion a year.
And that figure is predicted to top £16 billion by 2030, according to financial analysts Allied Market Research. Antidepressant drugs are claimed to lift the darkness of depression and it seems we need them.
Since the 1989 launch of the first modern antidepressant, Prozac, a drug known as a selective serotonin reuptake inhibitor (SSRI), diagnoses of depression in the UK have rocketed.
Figures from the Office for National Statistics for September to October last year show that some 10.7 million people — or 16 per cent of British adults — experience depressive symptoms.
Yet in 1997, a University College London study in the journal Psychological Medicine assessed 10,000 UK adults and concluded that a mere 2 per cent of the population had depressive symptoms.
A growing body of evidence suggests that the emergence of SSRI antidepressants has encouraged doctors increasingly to diagnose depression as an illness that needs medicating with drugs (stock image)
So what happened in those past 25 years? It may be that life has become harder, and that mercifully a new class of medication came along just at the right time to fix it.
However, a growing body of evidence paints a different picture. It suggests that the emergence of SSRI antidepressants has encouraged doctors increasingly to diagnose depression as an illness that needs medicating with drugs — even though too often these drugs don’t help.
Instead, researchers say, often the side-effects sink people into physical illness and steer them away from adopting healthy lifestyle habits that could make them feel lastingly better.
As Good Health can exclusively reveal, such concerns have prompted a new group of leading UK experts including parliamentarians, psychologists and doctors, as well as a former head of the NHS, to launch a campaign to reverse the rising tide of antidepressant prescriptions.
The group, under the aegis of the newly named Beyond Pills All Party Parliamentary Group (APPG) which includes nine professors of medicine and psychology, is today publishing an open letter in the British Medical Journal calling on the Government to take action.
The experts, who include the former chief executive of the NHS, Lord (Nigel) Crisp, the British Medical Association vice-president, Professor Sir Sam Everington, and the former head of the Royal College of Psychiatrists, Baroness (Sheila) Hollins, warn that long-term antidepressant use is associated with ‘many adverse effects, including weight gain, poorer long-term outcomes for some, sexual dysfunction, bleeding and falls’.
In their letter, the experts claim that rigorous analyses of study evidence show antidepressant drugs ‘have no clinically meaningful benefit beyond placebo for all but the most severely depressed patients’.
In May researchers at the Vrije University in Amsterdam revealed that when depressed people went running it relieved their depression symptoms as effectively as the SSRI escitalopram (stock image)
One of the authors, Dr Michael Dixon, a GP in Cullompton, Devon, who is chair of the College of Medicine, told Good Health: ‘Antidepressants are a blunt instrument. Our culture is biased towards them because we have medicalised unhappiness and want relatively instant solutions.
‘The problem of giving antidepressants in the first place is that with mild to moderate depression, up to 40 per cent will improve anyway, and up to 30 per cent will not improve in spite of antidepressants. So at least half of the people that we give antidepressants to would either get better anyway or won’t be helped by them.’
What’s more, says Dr Dixon, antidepressants can have side-effects that range from mild to serious, including a reduction in sexual desire and function. (Last month musician Ozzy Osbourne said taking them had halted his sex drive. ‘The one thing about antidepressants is it kills your sex drive instantly,’ the 74-year-old said.)
More disturbingly, as the mental health charity Mind, warns: ‘There is a possibility that taking an antidepressant could make you feel suicidal. It may happen even if you didn’t experience suicidal feelings before.’
However, such warnings are often the opposite of the positive messages presented in top-level medical journals, an analysis of clinical studies warned in August.
Researchers in Austria and Switzerland examined 27 papers published in the past 30 years which studied the link between antidepressants and suicide.
Ten of the papers warned of a link between taking antidepressants and a rise in suicide risk — one said the risk was six times greater. However, 17 of the studies said that they didn’t find clear links between antidepressants and suicide risk.
The authors of this new analysis found that researchers who received funding from drug companies were significantly less likely to report that antidepressants carry a risk of suicide.
What’s more, the analysts also found that top psychiatry journals were more likely to publish antidepressant studies that didn’t report the risk. This is crucial because clinicians and drug-policy chiefs give much more weight to conclusions published in high-ranked scientific journals.
Meanwhile, independent studies are now emerging to show the effectiveness of non-drug treatments for depressive symptoms.
In May, for example, researchers at the Vrije University in Amsterdam revealed that when depressed people went running, it relieved their depression symptoms as effectively as the SSRI escitalopram.
The runners were required to join two or three group sessions a week for 45 minutes, over a period of 16 weeks.
Brenda Penninx, a professor of psychiatric epidemiology who led the trial, said that the regular runners also enjoyed improvements in their physical as well as mental health, by losing weight, slimming their waists and improving their cardiovascular health.
In a trial recently published in the Journal of Clinical Psychiatry, 33 adults with moderate-to-severe depression had regular sessions of hot yoga — and results suggested it led to significant improvements (stock image)
By contrast, the participants who took the antidepressant drug tended to see their cardiovascular health worsen.
This concern about heart disease is echoed in a large study of British antidepressant-takers, led by researchers at Bristol University, published in the British Journal of Psychiatry Open last year.
Their data from more than 221,000 adults aged between 40 and 69, found that those who took antidepressants for ten years could double their risk of coronary heart disease and dying prematurely from all causes.
Ten years may seem an unusually long time to be on antidepressants, but the study reported that this is increasingly common. The Bristol researchers argue that this, rather than an increase in diagnosis, is the main reason why antidepressant prescriptions have nearly doubled in a decade.
Running isn’t a practicable alternative to antidepressants for everyone, however.
In a 16-week Dutch study, only 52 per cent of volunteers completed the running programme — while 82 per cent of the antidepressant group kept taking the medication.
Other alternatives may be useful. For example, in a trial recently published in the Journal of Clinical Psychiatry, 33 adults with moderate-to-severe depression had regular sessions of hot yoga — and results suggested it led to significant improvements, with six in ten of the yoga group experiencing a 50 per cent or greater reduction in symptoms after eight weeks, while four in ten were classified as in remission — or ‘cured for now’ at least.
Another healthy habit, eating well, may also help, according to a report in the Journal of Nutrition in October.
Researchers at the University of Illinois in Chicago studied the effect of diet among 540 pregnant women, focusing on this group, ‘because some 12 per cent of pregnant women in the U.S. are affected by prenatal depression’, where mental wellbeing declines during pregnancy.
Those who followed a healthy Mediterranean-style diet — rich in wholegrains, fruit, vegetables, olive oil and moderate amounts of fatty fish — were less likely to report symptoms of depression.
Since the 1989 launch of the first modern antidepressant, Prozac, a drug known as a selective serotonin reuptake inhibitor (SSRI), diagnoses of depression in the UK have rocketed (stock image)
Poor diets, by contrast, may increase the risk of depression, according to recent research in the Journal of Affective Disorders. Based on data from more than 23,000 people living in Melbourne, Australia, the study showed that, over 15 years, those who habitually ate the most ultra-processed food had the highest incidence of depressive symptoms.
Researchers from Harvard Medical School found a similar association in a study of 31,000 women, and suggest that artificial sweeteners might be a particular culprit. Writing in the journal JAMA Network Open in September, they said that recent lab experiments suggest that artificial sweeteners may cause damaging inflammation to brain cells.
But why would people taking antidepressant pills actually care about such findings? Quite apart from the potential side-effects such as those suffered by Ozzy Osbourne, one effect of these pills is ’emotional blunting’ — where people care less about positive and negative information.
This effect was reported in a study published earlier this year in the journal Neuropsychopharmacology by Barbara Sahakian, a professor of clinical neuropsychology at the University of Cambridge, based on responses of people taking escitalopram to a series of cognitive tests.
‘This may be in part how antidepressants work — they take away some of the emotional pain that people who experience depression feel,’ Professor Sahakian told Good Health. She still advocates the prescribing of
antidepressants, although she suggests patients should receive psychological support, too. ‘If a person with depression responds to SSRIs it is also useful for them to have cognitive behavioural therapy (CBT).
‘This will help them stay socially connected, get them out exercising, improve their sleep and help in many other ways to improve their functionality and enjoyment in life. In addition, CBT methods learned with the therapist may help to reduce the chance of a future relapse.’ For Dr Dixon, however, the answer lies in doctors helping patients to change their lifestyle, diet and social habits before prescribing antidepressants.
‘I always give my patients a choice of alternatives, from lifestyle to complementary therapies to conventional antidepressants,’ he explains.
‘Exercise has a very positive effect on depression: it doesn’t have to be hard. More than 5,000 steps is good and more than 10,000 steps even better.’
He adds: ‘Social interaction is also important in improving mood. And you are three times more likely to overcome depression if you take up a hobby.’ Such simple moves may seem like impossible challenges to people suffering depression, but Dr Dixon says such support is in theory available at every GP practice, because they all have access to a social-prescribing link worker.
Social prescribing is an approach that involves connecting people to activities, groups and services in their community that may help to improve health and wellbeing. ‘You and the link worker may be able to formulate a plan that provides meaning and sense to your life,’ Dr Dixon explains. ‘This may involve a whole range of interventions from help with debt, benefits, housing and employment to physical, social and arts activities.’
The new Beyond Pills APPG is urging the Government to commit to stopping the prescribing of antidepressants to people with mild depressive conditions and it wants ministers to fund services that help people to stop taking the antidepressants.
Experts stress, meanwhile, that people currently prescribed antidepressants should not stop taking these drugs without first consulting their doctors.
