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The Drugs Do Work 

What do you do when things you’d been told were true turn out … well, not to be as certain as you thought?

Mental health and the mind are complex - and the amazing thing about our modern research world is that we are constantly discovering new things about the amazing way the brain is designed.

What is tricky is when new findings appear to question things we may have felt were ‘accepted’ knowledge for a long time.

You may have seen many newspaper articles highlighting research that has apparently demonstrated that there is little evidence that a chemical imbalance causes depression. 

It’s pretty confusing, and if you or someone you love suffer with depression, or are taking the kind anti-depressant medication which apparently ‘fixes’ this supposed imbalance, it can be alarming. What should you do? How should you react?

It’s important to bear in mind that the way stories like this are reported is not always helpful.

Eye catching headlines are designed to grab your attention and often use anxiety to try to do that. They’re often not the most rounded or realistic portrayal of the facts. So what IS the truth that lies behind these reports?

Here are three things you need to know if you are concerned about this issue:

(1) Within the psychiatric community, the established consensus opinion is that the causes of depression are multiple. One of these causes could be your genes, which can make some people more susceptible, for example if a family member has depression, it is more likely that somebody else within the family may also develop it. There are also various so-called environmental factors, such as significant losses and stress - which may trigger depression in someone who IS susceptible. The idea that depression is merely caused by chemical imbalance represents a rather simple and misleading narrative therefore. 

(2) Similarly it is well established that antidepressants are effective. This is based on the highest level of available evidence which is the systematic review of multiple randomised controlled trials of antidepressants versus placebo. In order to demonstrate a drug's effectiveness, it is tested against a placebo (sugar pill). Although there are sometimes challenges in interpreting data and studies can be flawed from a variety of perspectives, overall the evidence is overwhelmingly that antidepressants are effective (the largest such trial, which was published in 2018 studied over 500 individual trials of antidepressants and demonstrated that they were more effective than placebos). In fact, the theories that depression might be related to chemical imbalance came from the discovery that medications which altered the levels of key chemicals, such as serotonin seemed to help so many patients who were struggling with symptoms of depression, and related conditions like anxiety. This does not mean every person reacts to every drug in the same way. Depending on your symptoms, and your individual response, a clinician may tweak and alter your medication to find the drug and dose that suits you. That is why working with a doctor or psychiatrist or team you feel you can trust and be honest with is so important.

(3) It is also established within the medical community that the exact biological mechanism of depression is not fully understood. The chemical activity of common antidepressants is relatively well understood but why this then helps to alleviate symptoms of depression is not totally clear. Chemical theories of depression have always been just one of many being investigated. In a lot of ways, this study does not actually present any new information. Antidepressants are well established as effective medications. The exact workings of the brain and how exactly antidepressants work is still a work in progress.

Remember this doesn’t mean that antidepressant medication is the best treatment for everyone - and many people benefit from treatments that combine medication with other approaches such as talking therapies. Studies have also suggested good results for some from more innovative approaches that look at how introducing positive activities into our lives and challenging the underlying factors that may be maintaining depression can help people feel better. Getting out into nature more, joining groups to reduce isolation and loneliness and finding ways to take regular gentle exercise have all also been demonstrated to be effective as part of combined approach therapy. 

If you have concerns or questions about any medication you are being prescribed for your depression, its important you don’t just stop taking it. Always talk to your doctor - your GP or psychiatrist - and get their opinion and support before you think about making any changes. 

As the psalmist puts it, we are ‘fearfully and wonderfully made’ - and the brain is awesome in its complexity, its intricacy, and in all the amazing things it does that make us who we are. We’re a long way from understanding EVERYTHING about how it works - but that doesn’t mean that we don’t have lots of really helpful tools for the moments that aspects of our minds and emotions are making us unwell. 

Dr Kate Middleton & Dr Chi-Chi Obuaya, 26/07/2022
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