Written by Niamh Williams
Antidepressants first emerged in the 1950’s and appeared to be a miracle drug for treating depression. Working on the basis that depression is the result of a chemical imbalance of serotonin and norepinephrine, antidepressants counteract this imbalance by raising the levels of these neurotransmitters, thereby treating the illness. In the same way penicillin had revolutionised medicine, antidepressants revolutionised the treatment of mood disorders.
But do antidepressants work?
In a review published in the Lancet a team of researchers analysed 522 studies for evidence of how effective antidepressants are as a treatment for adults with major depressive disorder. They compared 21 different antidepressants against placebo (in other words, patients received either the active drug or a sugar pill placebo).
Each study was conducted using a double-blind methodology, which is considered the gold standard of scientific research because neither the patients nor the experimenters know who is receiving which treatment, minimising any placebo effects or bias (such as the experimenters subtly influencing the patient).
The results indicated that all antidepressants were more effective than placebo. So, case closed, right? Antidepressants help people with depression by correcting a chemical imbalance.
Hold your horses….
In the last 70 years no research has conclusively found that depression is the result of a chemical imbalance. While much research shows that antidepressants work from pre to post intervention, those studies never measure whether increases in serotonin caused the improvements.
So, how do antidepressants work then? Well, there are two answers to this.
The first answer is this: we don’t know. If antidepressants do work when we don't know what they are doing that makes them work. We don't even know what biological system causes depression in the first place.
The second answer is this: they may not work. There is plenty of evidence out there finding no positive effects of antidepressants . Even that study in the Lancet has been critiqued in numerous ways.
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| The controversial study by Cipriani et al. (2018), published in The Lancet |
Why is this all important?
In England alone, prescriptions for antidepressants nearly doubled in just 10 years, from 36 million prescriptions in 2008, to over 70 million in 2018. Though antidepressants may seem like a fast, cheap and effective way to treat mood disorders, both medical practitioners and the general public must be cautious about the perceived benefits of antidepressant medication, given the frailties of the chemical imbalance theory.
The takeaway message
Don’t come off your meds. We are not saying that there isn’t a place for antidepressants. Many people certainly report that antidepressants get them out of a hole. However, it feels like we need to start figuring out what causes depression before we place too much confidence in any one treatment, especially one that can come with adverse side effects.
Don’t come off your meds. We are not saying that there isn’t a place for antidepressants. Many people certainly report that antidepressants get them out of a hole. However, it feels like we need to start figuring out what causes depression before we place too much confidence in any one treatment, especially one that can come with adverse side effects.
If you are interested in the history then Robert Whitaker’s brilliant book ‘Anatomy of an Epidemic' has recently been on sale for crazy cheap on Amazon. It's worth every penny, particularly while it's this cheap.