A Facebook post that became a short blog post:
Remember the recent Lancet analysis showing that antidepressants work. All that most of us “know” from those reports is that antidepressants work. Headlines everywhere. Expressed as fact and the final word on the subject. We don’t just believe it, we think we “know” it. We say we “know” many things. That doesn’t make them true.
But do antidepressants work? How can I even ask that when I have the Lancet study to hand, when it’s so impressive and when on the face of it you might conclude I shouldn’t even question such weight of numbers.
That question can be read in many different ways. It’s ambiguous and depends on how we define a positive outcome. It also depends on how we choose to measure and study that outcome. There have been some atrocious definitions in the past. A better question is whether any benefits to the patient outweigh any risks to the patient (such as the use of antidepressants dramatically increasing relapse rates**)?
That analysis only looked at one kind of evidence, and it’s a kind of evidence that’s pretty skewed. So this article by Robert Whitaker, explaining why that evidence is skewed and examining lots of other evidence, is very interesting. At least to me, who has taken a lot of antidepressants over the years. Read the article, see what you think.
There’s more than one way to examine drug efficiency. The narrative we’re given often only gives us one of them and it’s given in such a way that challenging the popularised narrative is almost forbidden. The Lancet and those researchers from the Royal College of Psychiatrists worked to one narrative.
I’m interested that their study specifically excluded certain patient groups from inclusion in the data. One of these groups was patients with treatment resistant depression. That is, if it’s known that antidepressants don’t work for you, you’re automatically barred from inclusion in a study on whether antidepressants work better than a placebo for patients with depression. Make of that information what you will. The very honest discussion in the paper admits to lots of weaknesses in the study, some of which are probably unavoidable in any academic study of randomised control trials.
I’m also interested that the study tells us that an antidepressant has better results in RCTs when it’s new than when it’s old. Isn’t that fascinating? The fact that a psychiatric drug becomes less efficient in tackling an “illness” over time has implications. We have to ask why. The “illness” hasn’t changed has it? It’s not like a virus becoming more resistant to an anti-viral medication.
Whitaker and many others challenge the antidepressant narrative we’re mostly given and sometimes sold. They challenge it after research, after examining available evidence. You don’t have to agree with them of course but be aware that the newspaper headlines about the efficacy of antidepressants don’t tell the whole story.
If you’re taking psychiatric medications I’m not going to tell you to stop. That’s your choice. I just want the possibility to be there that every patient’s choices can be made based on the full picture, not the narrow picture that we are almost consistently sold. Your medications may help you. That’s good. You may need to keep taking them – sometimes because of an underlying mental health condition, but sometimes because of their effects not because of any problem you have or had before being prescribed them. Indeed, you may have a serious illness that needs some kind of psychopharmacology to tackle distressing symptoms. I’m not totally anti-medication and you’re not weak or lacking because you take a pill – just as I have not been weak or lacking in any period of taking the drugs. And even if you do want to stop taking medication, I ask you to be very careful indeed and be prepared that it’s possible you won’t be able to stop.
As for me, I just wish I’d had all the information on which to base my own decisions of care. I wish I’d been empowered rather than robbed of power. I wish I’d been able to see the difference between misery and distress that’s normal and misery and distress that might need a pill. To be totally honest, I wish that I had never taken that first antidepressant. Or the second, third, fourth, … and so on. Perhaps, given my life and beliefs at that point, I couldn’t have done anything else. I wish that three years ago I hadn’t convinced myself that getting medication yet again was a good idea, that I’d been able to find other ways – or to be shown them by the medical profession and given options. In effect the consultation was “I’m suffering. Give me a pill.” “Okay. Here’s a pill. Come back if you need another one.” It’s taken a long time and I’ve hit worse lows while on the pills than I’ve hit for a very long time but I’m now able to be building my life more productively. And I’m starting to taper off the medications I’ve been taking. It feels good to be taking control of my own mental health. I have the support of my GP in coming off meds but the initiative is fully my own.
**I’m actually quite angry that I have never been informed by any medical professional or “expert” that use of antidepressants increases relapse rates. The evidence is out there. Crystal clear. I believe that for patients not to be told these kinds of things is a breach of their human rights and mental health rights. I was asked six years ago – in all seriousness – whether I wanted to find a way to sue and claim compensation for the way I’ve been treated. I said no, and couldn’t see how it would happen. Again in all seriousness I’m thinking of asking the person concerned whether that would still be a question he’d ask me. I don’t think any person intentionally mistreated me even though a lot of the time the treatment I’ve received has been dreadful. But the system in which doctors work did mistreat and that needs challenging. I don’t think the enthusiastic lobotomists or insulin coma doctors or givers of metrazol intentionally mistreated people either, or the ones who promoted neuroleptics for schizophrenia (whatever that is) and published studies that they didn’t produce serious side effects even though it was already known with absolute certainty that they did. If I could sue now, or raise up legal challenges, I would. Not for my sake but for the sake of everyone who is not given the full picture and is not allowed to make a reasoned decision.