Tuesday 3 December 2013

I am not depressed but...

It's a number one hit, the NHS medical miracle, not just in the UK but all around the developed world.
Yes, it's the antidepressant pill.


The use of these drugs has risen to ever higher levels across the developed world since the SSRI (selective serotonin re-uptake inhibitors) compounds were first introduced  in the early 1990s. A recent Guardian news paper story highlights the rising usage, http://www.theguardian.com/society/2013/nov/20/antidepressant-use-rise-world-oecd


Prozac (chemical name Fluoxetine) also known as SarafemLadose and Fontex and it's sister chemical Citalopram have radically changed the medical world's response to depression treatment.


They are used to treat anxiety, blushing, panic and all manner of nervous disorders. For some the treatment works well for others the outcome can be worse than the condition. The list of side effects is long and rather troubling (see the Wikipedia page for more information http://en.wikipedia.org/wiki/Fluoxetine) and although there may be only a low percentage of user that have suicidal thoughts as a result of taking the tablets, some will act on those thoughts.


So ban them then?


The flip side of the coin is how many people would have taken their lives if they had not been taking anti-depressants? In fact according to the NHS higher usage of the treatment coincides with reducing suicide rates (http://www.nhs.uk/news/2013/07July/Pages/Prozac-nation-claim-as-antidepressant-use-soars.aspx)


So a ban seems unreasonable.


So are we really using them correctly? Are GPs just a bit too keen to pick up the prescription pad instead of looking at alternative approaches? Probably.  However talking therapies (CBT, Counselling, even hypnotherapy) take time, skilled staff and....money. Drugs are relatively cheap, typically start working within 6 weeks and for most cause few side effects.


The problem is that they do not changes the patient's situation or thoughts patterns associated with the situation. It's a chemical fix for a life problem in many cases. It would appear that there are far more prescriptions issued than there are depressed people and so it seems we are trying to actually treat unhappiness in many cases.


Unhappiness is though, a completely natural condition, all of us will be unhappy at some point. It happens when we compare our situation as it is with the situation that we want or have a mental model of. That desired model may be unrealistic (talking therapy may help) or it may be realistic in different circumstances. (Can the patient change the circumstances?). But unhappiness is not depression and we should stop trying to treat it with drugs. As for life models not to follow, avoiding the celebrity news in the Daily Mail and elsewhere might be a good place to begin.