Chemical Welfare

By Anthony Rowan

Depression is something that affects many of us, and if you believe that you’re not truly depressed until you can write good poetry then you’re mistaken.

According to Glaxo-SmithKline, there are five million people suffering depression in the United Kingdom. Hundreds of millions around the world use antidepressants like Seroxat. Being clinically depressed does not have to mean that you’re manic or suicidal: the Diagnostic Statistical Manual lists over three hundred manifestations of depression, many of which we could all recognise in our own behaviour.
The problem here is that to define depression authoritatively in the broadest of terms not only gives pharmaceutical companies a lot of freedom in the way they are allowed to market drugs, but it also may only make the use of antidepressants seem more acceptable to doctors, psychiatrists, and the public. Given the possibility of a GP not having enough time to spend five minutes with a patient before diagnosing depression and prescribing drugs, should we not be more aware of the possible risks associated with antidepressants?
The issue of antidepressants and dependence remains a contentious point. We can talk of the habitual prescribing of dependence-producing drugs for anxiety, insomnia and related problems that go by a thousand other names. Over the past two hundred years, doctors have prescribed an almost uninterrupted succession of ‘addictive’ drugs, always in the belief that they would not cause dependence or that patients would be mainly responsible if they did.

Think alcohol, opium, morphine, heroin, cocaine, barbiturates, benzodiazepine… The list goes on and, in their time, all of these have been prescribed to treat mental distress. They have also, with the exception of alcohol, been prescribed as a weaning treatment for patients addicted to other drugs on the list . Whether or not antidepressants can be described as “addictive” (the Royal College of Psychiatrists is deliberately misleading, stating that they are not “addictive” in the same way as nicotine or heroin ), drugs like Prozac and Seroxat commonly cause uncomfortable side effects (between 15% - 20% of people stop taking their tablets straight away ). Seroxat in particular can cause withdrawal symptoms varying from unpleasant to so severe that patients are unable to stop taking the drug at all without great difficulty. GlaxoSmithKline (and most professionals, it seems) do not believe that the side effects outweigh benefits. In fact, they consider it dangerous to the health of people suffering from depression that the effectiveness of antidepressants should be questioned, as it “may lead patients suffering from depression to discontinue their treatment, with potentially serious consequences” . This is a persuasive argument: depression is a very real and an often life threatening condition, and it is not in doubt that the diagnosis and treatment of depression is crucial. Let’s make this clear: drugs do work and they save lives; but while it would be irresponsible to suggest otherwise, it is equally irresponsible to suggest that they are the answer to all of our problems. In treating a problem, drugs can create more problems, both physical and social. Antidepressants alone cannot treat the causes of depression, and so our relationships with doctors, drugs, and the pharmaceutical industry need to be questioned. Do so many of us really need antidepressants?

Let’s talk about what we know about depression and how antidepressants work. Lack of a neurotransmitter, serotonin, is thought to cause depression, and antidepressants like Seroxat (that is, SSRIs) fix this problem. You have probably heard this kind of explanation before? Well, arguing that depression is no more than a chemical deficiency like diabetes, is over-reductive, has no scientific basis and, as it is, it leaves many questions unanswered . For example, why is it that older antidepressants are just as effective as SSRIs, even when they hardly act on serotonin? Actually, since the first antidepressants were introduced in the late 1950s there has been no improvement in effectiveness: they have shown themselves to work in about 50% - 65% of all cases , and this is true for every type, whether MAOIs, tricylics, or SSRIs. And why is it that roughly one quarter of all cases resists treatment with drugs? This points to what we all already know: depression is a far more complex disease, with psychological as well as biological factors involved, and our attempt to treat it with drugs seems to be no better than fumbling in the dark.

The selling point is not that SSRIs work better than any other drug, but only that they are supposedly safer than others. What seems more important is that drug companies need us to use new drugs, because they are far more expensive than equally effective older drugs, and they provide the money needed to research new drugs and, thereby, sustain the pharmaceutical industry.

So, do so many of us really need antidepressants? It has already been mentioned that drugs work on depression in around 50% - 65% of all cases. A fascinating point is that approximately 25% - 30% of cases respond to placebo . And what’s more, there is no difference in the quality of the response. That means that consistently in 25% - 30% of cases, a sugar pill works just as well as the best active drug. If you believe the previous argument that the cause of depression is entirely biochemical, then this presumably means that a lot of people are faking depression. However, accepting the complex nature of depression, the fact that a placebo is often as effective as a drug suggests that for some people, all that is needed is a symbolic exchange and the feeling that something concrete has been done to defeat the depression. It would be unfair to say that these depressions are unreal or hypochondriacal, but it would suggest that the way depression is portrayed contributes to our sense that we “need professional help” when we are unhappy with life.

The placebo effect should not be viewed negatively, as if we are “fooled”: it is evidently a very powerful method, and cuts both ways. Actually, in terms of cost, risk, and effectiveness, there is evidence to suggest that treating depression by placebo makes some sense. This may not seem plausible, being unreasonable to suggest doctors (in effect) lie to patients when prescribing a placebo, but it has already been going on for a number of years. With the older tricyclics, there is evidence indicating that doctors frequently prescribed their patients a dose that an expert would judge to be chemically ineffective. This is essentially the same as prescribing a placebo.

Think about it, do so many people really need drugs, or do drug companies just need us to think that we do? When so many people believe that any kind of idealism is naivety, I cannot understand how so many people can be so naive as to put their trust into such massive, capitalist organisations. It is not at all cynical to say that exploitation is intrinsic to any organisation with an intention to make profit, and while we consumers are not guiltless in this system, “on the face of it, government and regulatory authorities, the leadership of the medical profession, and the pharmaceutical industry have much to answer for”