Some Doctors Want More People Taking Antidepressants

Damn the side-effects, full speed ahead!

By William M Briggs Published on February 26, 2018

There are calls for “at least a million more Britons” to be put on antidepressants. This is odd because Britain’s National Health Service already “prescribed a record number of antidepressants” in 2016.

That represented “a massive 108.5% increase on the 31 [million] antidepressants which pharmacies dispensed in 2006.” In the States, one estimate is that 12% are already on these drugs.

Still, the clarion for ever more drugs was signaled after the results from a new statistical analysis were announced.

The Study

Do antidepressants alleviate or ameliorate the suffering caused by acute major depressive disorder? In some cases, the analysis, published in The Lancet, says the answer seems to be yes. Which means that in some cases, the answer appears to be no. This is another way of saying that antidepressants don’t always work, or don’t work for all people all of the time.

And that means that, at least for some, placebos are as “effective” as the active chemicals in antidepressants. The authors admit, “Depressive symptoms tend to spontaneously improve over time and this phenomenon contributes to the high percentage of placebo responders in antidepressant trials.”

Placebos, it should go without saying, do not carry any risk of side effects. Actual drugs do; about which, more in a moment.

Caution Over the Results

Now this was not an original study, but a re-look at old studies called a “meta-analysis.” As a statistician, I only often half-jokingly say that meta-analyses are conducted to “prove” what individual studies could not. If the results from individual researches were clear and robust, meta-analyses would hardly be needed. On the other hand, a meta-analysis can provide a vantage individual studies cannot. The limitations of the method must be kept in mind.

Only studies that treated acute depression were examined here. What about side-effects? Cipriani cautioned “that some of the adverse effects of antidepressants occur over a prolonged period, meaning that positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration.”

The result of the meta-analysis indicate antidepressant effectiveness is not strong, classed as medium to small effect sizes. The authors warn “Given the modest effect sizes, non-response to antidepressants will occur.” Meaning not all who are given drugs will react to them.

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Now the study’s reported statistical measures are highly specialized and take definite meaning only inside a mathematical system. The details are too technical to go into, but naive use of reported measures can exaggerate effectiveness.

Why do I mention this? Because the effect sizes are not as impressive as they might appear (especially to the media). Another caution: “The effect sizes were also smaller in more recent and larger placebo-controlled trials than in older and smaller ones, which might be an indicator of bias.”

Causes of Depression

All this makes the calls for boosting the number of people given drugs curious. Especially since the long-term side-effects are not accounted for. Nor are things like this.

The push is on, however. The Telegraph is behind the cause. It announced that fourteen is “average age of onset for depression, as diagnosed now, compared to 45 in the 1960s.” They also say there was a 166% “rise in young people who talked about suicide during Childline (UK) counselling sessions in 2013/14, compared to 2010/11.”

If these numbers are right, and given there has been no widespread new organic causes of disease, then something in the culture has dramatically changed. Wouldn’t it be better to fix these cultural sources of despair, rather than identifying all of it with clinical depression and then treating its symptoms with drugs?

Side Effects

Antidepressants, as said above, give rise to the possibility of side-effects. Two of these include suicide and homicidal ideation. Meaning having thoughts about killing people.

Violence and antidepressants are not strangers. One study found “violence disproportionally reported for 31 drugs.Most were antidepressants and those drugs used to treat attention deficit hyperactivity disorder, a popular diagnosis for high-school-aged boys. The Center for Disease Control reports the “percent of children with an ADHD diagnosis continued to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011-12.”

One explanation is that as more people understand ADHD and depression, they are more likely to go to the doctor. That would cause the number of diagnoses to go up. The other explanation is that the meaning of these maladies broadens because of cultural factors.

The latter explanation best accords with the skyrocketing rates of antidepressant use. In 1988-1994 (in the States), less than 2% of 18-44 year-olds and 3% of those 65 or older taking them. Now it’s 9% and 19%.

Since the call is for more diagnoses, there’s nowhere for these numbers to go but up. That must mean an increase in the number of side-effects and the damage they bring.

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  • Patmos

    Blessed are those who mourn, they shall be comforted. The power of the Holy Ghost is no match for affliction. The shield of faith blocks all the fiery darts of the wicked, and the sword of the Spirit is the word of God.

    The modern health care industry is one of the great evils in the world today.

    • Ken Abbott

      Excuse me?

      • Patmos

        The health care industry is more industry than health. I don’t deny some of the good it’s done, what I do take issue with is the expense at which that good has come, and just who really benefitted.

        • Alice Cheshire

          The mental health industry, which is not really mental at all or you wouldn’t be calling it euphamisms like chemical imbalance, is the reason. Drugs are easy and covered by insurance. Once the chemical straightjackets let the mentally ill out of institutions and we convinced people these were “fixes”, it was a smooth ride. Don’t just blame pharmaceuticals, though. People are lazy and want fast fixes. They voluntarily take the meds. It’s people choosing this.

          • D McGovern

            Yes, that is true. But it is also true that doctors are “encouraged” financially to push big pharma’s wares and it is also true that depression is very, very difficult to live with months, years on end and people get desperate. I willingly went on anti-depressants when I started to lose my temper with my young daughter after suffering for years and previously being , let’s say, “impatient” with my older children. I was then diagnosed with bi-polar. Over 10 years later, after forgetting to take my “meds” several days in a row with no apparent ill effects I decided to stop taking them. I not only had NO side effects but the fog cleared from my thinking and I WOKE from my slumber. Have not looked back since. Of course I do lean on the Lord God and pray at the first sign of trouble. However the issue of pharmaceutical treatment for mental and emotional problems is a complex one. But as to Wm Briggs’s point – why on earth are drugs being pushed on children when there is no indication they will have a significant and safe effect? Why indeed? I think we can all guess. BTW I am not suggesting anyone else quit cold turkey – just saying it worked for me. Don’t all hit me with your umbrellas.

          • Ken Abbott

            “But it is also true that doctors are ‘encouraged’ financially to push big pharma’s wares.”

            We are? Boy, have I been missing out if this is real…

            D McGovern, I receive no more or less compensation for the medical care I provide based on the medicines I prescribe. To the best of my ability, I rely on solid clinical data of efficacy and tolerability and ignore advertising or sales pitches (I don’t permit pharmaceutical detailers to have any more access to my office than to leave educational material for my private review).

          • Bryan

            If there were more doctors like you, there would be fewer articles like this I’m sure.
            Thank you for serving your community!

          • Ken Abbott

            Thank you. Credit my mom and dad–they raised me right!

            By the way, if my own decades-long experience is reliable, I am far more the rule than the exception. It’s just that the rules are boring and the exceptions get all the press.

          • D McGovern

            I said encouraged. It is the choice of individual doctors to succumb or not. Obviously if you don’t permit pharma detailers any more access than to leave educational material for your private review you could, if you chose, permit more than that. And some do.

          • Ken Abbott

            You also put encouraged in scare quotes. I took that as nuancing the word but wasn’t sure in what direction you meant.

            You’re right that individual practice varies. Many of my colleagues are convinced that pharma sales detailing has no influence on their prescribing decisions, and I have to respect that if I have no evidence to the contrary. My practice since the beginning of 2009 when the new pharma rules went into effect is to very strictly limit contact with company reps. I find this has not hindered my ability to learn about new medicines and new developments with old ones one bit.

        • Ken Abbott

          The problem is in the size of the brush you used and the unnecessarily strong language employed. “One of the great evils in the world today” places it right alongside disease itself, war, terrorism, and slavery.

          When you consider the havoc wreaked in small rural communities a hundred years ago when diphtheria came to town; the 20 million estimated killed by the Spanish Flu pandemic that followed the First World War; the near-ubiquity of polio victims up to the middle of the last century; the world-wide devastation caused by smallpox; the ravages of childhood cancers; and the certain death sentence for victims of diabetes mellitus, you gain a better appreciation for the advances that we have seen and the great good that has often come about. Of course there is a cost attached, and we are now having to come to grips with spiraling medical costs in a society that prefers not to have to make hard decisions. It’s on us to use these tools wisely and beneficially and to separate their proper use from abuse.

  • Elizabeth Litts

    I am on anti-depressants and am seeing a Christian councelor. I don’t love God or have an less ‘faith’ than those who do not. I believe that My Lord wants me to care for my health-both mental and pysicall- so I can serve him to the best of my ability. I just get so tired of ‘Christians condemning those of us who need help with a chemical imbalance . Do you tell the diabetic who needs inslin that they don’t have ‘faith’? Do you tell a cancer patient that chemo is ‘lack of belief”? I hope not.

    • Patmos

      Continue in his word, and you will know the truth and the truth will set you free. Get ahold of the authority given to you as a believer, Luke 10:17-20 is a good place to start.

      You need not feel shame for your level of belief. For Jesus ever liveth to make intercession for you. At the same time, the same power that raised Christ from the dead is available to all who believe (Ephesians 1:19).

      If God is for you, who can be against you?

    • Bryan

      Ms. Litts, you are not weaker or of less worth because you are taking anti-depressants. I agree that the Christian community often gives the quick answer, “you just need more faith”. Maybe that’s true but to get to that place takes work, more work for some than for others.
      Also, from your comment you are not ultimately trusting in the meds to fix you. The meds help you get help. You’re seeing a counselor and that’s great!
      Ultimately, I don’t think Mr. Briggs’s article is meant to condemn those who take anti-depressants or other similar drugs. Rather, I think he is condemning those who carelessly prescribe them to those who don’t really need them in the pursuit of money or control, or sometimes, just sheer ignorance. There are some for whom these medications work and do what they are supposed to be meant to do: help people who need help have the ability to get help without becoming wards of the state or worse. As I said earlier, It seems to be doing that in your case and that is wonderful.
      I pray that God’s grace will continue and that one day you’ll be able to put the meds down and live fully without their help having been healed fully so you can share your life with others who struggle.

    • Alice Cheshire

      Back it up there, darling. I am a diabetic and swear if one more person uses the (*&^**( example you used….You are an arrogant and completely uniformed using a comparison that is SOOOOOO WRONG. Diabetes is NOT A CHEMICAL IMBALANCE THAT CANNOT BE MEASURED. Diabetes is the death of a pancreas. Type 1 is 100% NOT preventable. Yet you DARE to compare a physical, measurable illness to depression. You make light of a chronic illness that KILLS. I consider that outright evil.

      • Tim Pan

        You hostile response was uncalled for!

        • Alice Cheshire

          Why? People draw false equivalents that are damaging to others and I’m supposed to just smile and let it go? No, she is damaging to people who have verifiable physical illnesses. There is nothing similar between depression and diabetes, but people feel free to denigrate diabetics by making that comparison. It’s flat out rude and wrong. I won’t let people do this—I’m frankly tired of letting people make things up and repeat them to feel better. If reality is insulting, then so be it.

          • Ken Abbott

            Granted that the pathophysiology of diabetes mellitus and depression are greatly different, the two conditions do share a basis in biochemistry and physiology–they are both physical disorders, diabetes more uniformly so than depression, which is actually a more complex illness in that it has other factors than just the physical. I don’t consider it “denigration” to compare diabetes and depression, although a balanced comparison will draw out the contrasts as well. Both are typically chronic and often debilitating illnesses that represent major challenges to quality and often length of life.

          • Alice Cheshire

            So how does one test for chemical imbalances? How was the original study done? Your claim is depression is physical like diabetes, but I see no evidence thereof. It denigrates because diabetes is verifiable, decades old disease, not a “here are your symptoms so we’ll call it chemical imbalance and make it a disease” claim. If you could actually test for the “chemical imbalances”, you’d not be guessing at what meds to use, adding anti-psychotics, etc. Depression would never get better without the meds, yet it does. With diabetes (type 1), you need insulin or you die. Regulating the dose may be tricky, but there’s only one thing that treats the problem. You cannot use talk therapy and cure it. There are no silimarities. None.

          • Ken Abbott

            To the best of my knowledge, one doesn’t test for chemical imbalances because the pertinent ones don’t show up in accessible body fluids. But the problems with neurotransmitters are recognized from other research and it is well established from brain biochemistry and neurophysiology that there is some basis in physicality for many people who suffer from depression. That it is a multifactorial disease just makes it more complicated. Medication should be just one part of the overall plan for managing depression. Many people who have depression may not need medication; a good mental health care provider recognizes this, and if the tool is not suitable it won’t (or shouldn’t) be used.

            In this regard, diabetes mellitus is a “simpler” disease, because it is caused by a measurable problem with insulin biophysiology. Talking to a diabetes counselor helps with lifestyle and treatment education, but no one is counseled out of diabetes (unless you want to take the argument that a type II patient who is convinced to lose weight, eat healthy, and exercise more overcomes her glucose intolerance problem and the disease abates).

            We can’t be so black and white, Ms. Chesire. There are legitimate similarities between depression and diabetes, but there are more dissimilarities. Apples and oranges, perhaps, but at least we’re still talking fruit.

          • Alice Cheshire

            YOU can’t be so black and white. I can and will be. I’m tired of made up “diseases” and the drugging of the world. It’s morally wrong and it’s twice as wrong when you try and compare this to REAL diseases. I consider that unethical and completely dishonest.

            Comparing fruit? Medicine is now okay with “it’s all in the nearly same or ‘close enough for the average leyman’ catagory”? That is terrifying. Cancer, fibromyalgia, ADHD, diabetes, heart disease, depression are all just one big happy biological flaw.. Medicine is truly the enemy when we start seeing everything as something to throw a pill at and are happy to confer the term “disease” to anything we have a drug for. Once upon a time, the term disease actually meant something. It’s meaningless now.

          • Ken Abbott

            My best to you, Ms. Cheshire. I sincerely hope you obtain an optimal outcome from management of the diabetes.

          • Bryan

            No one is saying Diabetes, especially type 1, is a picnic. It can be manageable, but it can’t yet be cured. (I pray that a day comes soon when that disease can be cured.) In fact this thread started because one person thought others weren’t taking their disease seriously enough. In her case, Christians especially tend to be more insensitive because they tend to think a mental illness can be talked or prayed away. In some cases it can. And to those people, the prescription of drugs is a failure of medicine. For some people there are issues that require medication to assist in order to allow the talking and praying time to work.
            Again, none of this is to say that ailments that are physical, such as diabetes, cancer, the common cold, don’t matter. Even in those three there are major hurdles we have yet to overcome. None of these are completely preventable. Type 1 Diabetes is genetic (I think). We don’t know enough about cancer to say for sure how to prevent every case. The common cold has to be fought off by a relatively healthy body but you’re pretty much guaranteed to get it multiple times in your life.
            Disease incorporates a large spectrum of illnesses. I agree that there are diseases that get over-diagnosed or over medicated and that is a failure of medicine. That is what the article is about. Not which disease is more of a disease than some other disease.

          • Tim Pan

            You over reacted. You obviously do not understand mental illness. It is as real as a broken leg or a heart attack. Depression kills by suicide. If you are a Christian you know we are to do all things in love. You could have made your point in kindness. Instead of taking your frustrations out on her. Please send her an apology. And ask her about her illness and you can share you challenges.

    • Tim Pan

      The Lord said “…In this world you will have trouble. ” Well I have not been disappointed.

  • Kevin Quillen

    Side effects,the dirty secret the media won’t talk about because they are complicit along with politicians. Big Pharma pays big money to keep the side effects secret. Most mass killings were caused by drug side effects. Notice that the news has not been talking about this? Our system is corrupted by big business money buying politicians. God help us.

    • Alice Cheshire

      Big Pharma doesn’t need to pay the media. People line up for quick fixes. Plus, people worship the media. That is their choice—living in social media is not accomplished by force. Blaming the seller because there’s a huge market is morally bankrupt. People BUY into this 100% because it suits their views of life. It’s the buyers, not the sellers, that keep the market going. Unless you’re saying Americans are very stupid and uneducated and cannot be trusted to make their own choices—wait, that was your description of the drug industry. Yet you argue that this is wrong with the drug companies.

    • Ken Abbott

      Well, maybe the media won’t talk about side effects (but then how to explain those incessant ambulance-chasing ads I see on television) but we in the clinics and at the bedside certainly have to know and discuss side effects. As for keeping them secret, ever seen one of those voluminous product inserts that come in the drug packages? Maybe the print is small, but everything’s covered for those who care to read them.

  • Tim Pan

    I am taking an antidepressant. The change in my mood is nothing less then a miracle.

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