Even before Covid, mental health issues were on the rise accompanied by significant increases in spending and in use of medications. Despite this, the problems continued to increase. The advent of lockdowns in response to Covid has made the situation worse, in particular for young people and those whose livelihoods and businesses were lost.

In an era when we have been told to “believe the science” it is interesting to look at the evidence for use of antidepressants. A review published in April examined a question not previously asked about their use.

“Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression.

A cohort of people treated with antidepressants was compared to a cohort who was not. No significant difference was found between the two groups in either physical or mental component summaries (based on patient feedback).

The study concludes “The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time”.

A review published in December 2021 “… suggests antidepressants are overprescribed and that the efficacy of these agents is questionable”. Study co-investigator Mark Horowitz of University College London told Medscape “Antidepressants have never been shown to have a clinically significant difference from placebo in the treatment of depression”.

This is not to say that medications do not have a legitimate role and anyone who is taking them should not stop abruptly and without discussing with their doctor.

However, this builds on previous work showing that in mild and moderate depression SSRI medications may be no more effective than placebo. People feel better but it is because they are taking a tablet rather than because of the effects of the tablet.

In teenagers SSRI medication shave been linked to higher rates of suicidality and they are not recommended in this age group.

All this tells us that we need to look for other treatment approaches aside from and /or in addition to medications.  Despite the fact that there is evidence for simple lifestyle measures making a difference, these do not get much air time.

Research from the University of Technology Sydney showed 36% of young (18-25) year old males had a reduction in symptoms when following a Mediterranean type of diet. A few years ago, a similar finding was made in young women. If a pill reduced symptoms in over a third of people, it would be on the front page.

It has been shown repeatedly that regular physical activity improves mental health as well as sleep. There is also a connection between better sleep and better mental health. It does not need to be complicated. Simply going for a walk is suitable exercise. And if it is outside- even better as time in fresh air and /or nature is separately shown to benefit mental health.

Maybe this is all too simple and goes against our current world view that unless solutions are complicated then they cannot possibly work, or even help. The reality is that reducing intake of processed sugary foods (regardless the number of ticks, stars or elephant stamps they get), eating more food like our ancestors ate (food which till recently was growing somewhere or moving around), being active and getting enough sleep are all pillars of good health.

Add to this managing stress, be it meditation, relaxation, music, or other methods which work for you and seeking to deal as best possible with the underlying cause of stress also makes a big difference.

As we move into a post pandemic world, there will be challenges for all of us. Getting the basics of health right is an important foundation for all.