There is a great quote by Milton Friedman which says “One of the great mistakes is to judge policies and programs by their intentions rather than their results”. The same can be said of medical interventions.
We are constantly told of the crisis in mental health and that the solution is more funding, more awareness and more treatment. Yet the reality is that spending on mental health has never been higher, awareness has never been greater and the number pf people being treated has never been more.
According to the New York Times “Long-term use of antidepressants is surging in the United States, according to a new analysis of federal data by The New York Times. Some 15.5 million Americans have been taking the medications for at least five years. The rate has almost doubled since 2010, and more than tripled since 2000”.
The report adds that 25 million adults have been on antidepressants for more than two years which is a 60% increase since 2010!The increase in numbers is similar in other western countries (UK – double in the last decade) including Australia. Meanwhile, the suicide rate in Australia has not altered in nearly 30 years.
Previous reviews have shown that SSRI antidepressants are no better than placebo in mild and moderate depression. It has also been shown that when unpublished data is combined with published data that the benefits of certain antidepressants reduces from 98% to 50% (placebo effect).
Yet there is another aspect which I was not aware of which was reported in the New York Times “The drugs initially were approved for short-term use, following studies typically lasting about two months. Even today, there is little data about their effects on people taking them for years, although there are now millions of such users”.
I have written previously about the great pharmaceutical short where medications are trialed on a small group of people for a short period of time and then prescribed to a large number of people for a long time. One of the problems this leads to is that we do not know the long-term effects, including side effects.
The Times article centred on withdrawal from the medications and the difficulty that many people had in coming off these medications. Psychiatrist David Healy has written extensively about this. Cochrane Collaboration co-founder Peter Gotzsche is another strong critic.
Withdrawal was not something that would have been evidenced in trials lasting two months. Another aspect that would not have been studied is the impact in pregnancy. Numerous studies have raised questions about the impact of SSRI medications on the developing brain.
It is absolutely the case that we do not know. It is therefore interesting to contrast the sanguine attitude of public health to the use of antidepressants in pregnancy to the consumption of even one glass of a beverage containing alcohol. Excess alcohol consumption can have serious effects on the developing foetus. Yet women are made to feel guilty about the odd glass of wine (which will do no harm) because public health lacks the ability to trust women to make sensible decisions.
Ultimately the biggest issue is the diagnosis of depression and the increasing labelling of every bad hair day or tinge of normal sadness as depression. Necessarily bad things happen and we can feel sad. This is no more a medical condition than feeling happy about winning the lottery. Not surprisingly if the problem is not depression, then taking an antidepressant will not fix it. Of course, the act of taking the tablet (placebo) can make people feel better – the power of the mind.
If more prescriptions for antidepressants were the solution, then the dramatic increase over the past decade or two should have society happier than ever. Clearly this is not the case. Telling everyone (and teens in particular) that they lack the capability to deal with any stress and that every emotion is the sign of a mental health problem creates two major problems. One is that people take medication un-necessarily and can end up having difficulty getting off them. And secondly, the real problem is not dealt with and people are encouraged to regard themselves as helpless victims.
It is time we re-examined the current brain biochemistry model of depression and our willingness to seek and to prescribe medications for human emotion. It is also time we rediscovered the notion of resilience and dealing with what is in front of us, which does not exclude seeking help.
If you have concerns about your mental health call Lifeline 13 11 14
Medical Doctor, author, speaker, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.
Joe writes for numerous medical and mainstream publications, is clinical editor at Medical Forum Magazine, and is also a regular on radio and television.
Joe is Medical Advisor to Medicinal Cannabis Company Little Green Pharma, Chairman of Australian Tobacco Harm Reduction Association and sits on the board of Arthritis and Osteoporosis WA. He is often called to give opinions in medico legal cases.