It’s official: antidepressants work.

They are not a multibillion-dollar conspiracy dreamed up by Big Pharma Bond villains. They are not a snake oil distilled in secret laboratories, designed to stupefy us all. They are not a futile cop-out from overextended family doctors.

They are an effective treatment to alleviate symptoms of depression, a global scourge that affects as many as one in 20 people on the planet. Even the least effective antidepressants are better than placebos, the sugar pills dished out in trials. And placebos are better than nothing.

The drugs do work: antidepressants are effective, study shows Read more

The upshot of this, the most intensive piece of meta-analysis ever conducted into antidepressants, is that the millions of people (including me) who take them – reluctantly, sceptically, hopefully – can continue to do so without feeling guilt, shame or doubt about the course of treatment.

Moreover, doctors should feel no compunction about prescribing these drugs, though really they should be reserved for serious cases, and should be offered as part of a mix of interventions such as CBT, group therapy, work sabbaticals, mindfulness-based cognitive therapy, exercise, education and local support networks.

Doctors might also consider changing the specific antidepressants they are dishing out: the league table that has emerged from this six-year trial is a thing of great esoteric beauty, fascinating to those on first-name terms with these medicines. The big surprises are that the two best known – Prozac (fluoxetine) and citalopram (mostly widely prescribed in the UK) – are relatively poor at their job.

Of course, this is not the end of the story. The other big questions that have dogged antidepressants have not gone away: why they work for some and not for others (though this is the same with other medicines); why they take so damn long to kick in (anything from a few weeks to a few months) and HOW they work (the rather vague science is that they slow down the reuse of an important neurotransmitter, serotonin, deficiencies of which affect everything from mood and appetite to sleep and concentration).



The other big question that will persist for at least as long as it takes to gather proper evidence, is what the long-term side effects of taking antidepressants are. Most people quit taking them within the first year of being prescribed. But an important minority take antidepressants as an open-ended treatment: they have tried life without and it doesn’t work.

Who knows what the impact of a lifetime’s usage might be. But then again, something’s got to get you in the end.

Mark Rice-Oxley is a Guardian editor and author of the depression memoir Underneath the Lemon Tree