Not long back in Melbourne after the ISPS conference in New York City. As a longstanding member of the ISPS Exec and editor of ISPS’s scientific journal ‘Psychosis’ I am obviously biased, but it was pretty cool to be among 750 kindred spirits for five days. Have a look at the two thoughtful reviews of the conference by MIA writers Noel Hunter and Sandra Steingard – and then consider joining us in ISPS. Ok; advertising over!

Rather than write about my usual main focus of psychosis, I thought it timely to talk a bit about depression and antidepressants. My undergrad lectures on depression start with ‘This will be a short lecture. Depression is caused by depressing things happening – end of story.’ Of course I go on to talk about the various factors that make one person only a bit depressed and another very depressed after the same depressing thing has happened. (Including, of course, the number of other depressing things that have happened prior to the latest depressing thing).

I try to get across the basic idea that there is not something called ‘depression’ or ‘major depressive disorder’ or ‘depressive illness’ inside people that causes them to feel depressed – the mistake that so many mental health professionals, encouraged by big pharma reps, seem to make. My favourite example of this silliness is research showing that suicide is caused by something called depression and that therefore the way to reduce suicide rates is to identify and treat (with drugs of course) people with this thing – rather than identifying depressing things and doing something about them.

Anyway, I thought I would make a small contribution to the discussion about how coverage of the recent airline tragedy focuses so much on the supposed ‘mental illness’ of the pilot and not so much on the possible role of antidepressants. Of course we will never know the answer to these questions but it is important, I think, to combat the simplistic nonsense wheeled out after most such tragedies, the nonsense that says the person had an illness that made them do awful things.

So, just to confirm what many recipients of antidepressants, clinicians and researchers have been saying for a long time, especially the prolific David Healy, here are some findings from our recent New Zealand survey of over 1,800 people taking anti-depressants,1 which we think is the largest survey to date.

Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Agitation 47%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39%, and Feeling Aggressive – 28%. If one had to imagine a combination of feelings most likely to increase the chances of a tragedy involving the loss of multiple lives it would be hard to do better than emotional numbing, agitation, aggression, suicidality and caring less about others.

Although we cannot know whether these findings are relevant to the recent tragedy it certainly seems that antidepressants do have a broad array of adverse emotional and interpersonal effects and that these effects are far more common than previously thought. Of course an online survey runs the risk of attracting people with an axe to grind – but 82% of the respondents also thought that the medication had reduced their depression.

Given that recent reviews have found that these drugs are no more effective than placebo for the majority of recipients, we also tried to enhance our understanding of the placebo effect by investigating which psycho-social variables were related to whether respondents thought the drugs had worked.2 We found that perceived effectiveness was significantly related to a range of non-pharmacological variables, including: the quality of the relationship with the prescriber, being fully informed about anti-depressants by the prescriber, holding fewer social causal beliefs about depression, not having lost a loved one in the two months prior to prescription, and – somewhat paradoxically perhaps – belief in ‘chemical’ rather than ‘placebo’ effects.

It is worth mentioning that even a group of people who had accepted a biological treatment for their difficulties and had (mostly) found it helpful, did not unquestioningly swallow the ‘chemical imbalance’ theory of depression (and everything else) espoused by biological psychiatry and the drug industry.3 The most strongly endorsed causes were: Family stress (90.8% ‘agreed’ or ‘strongly agreed’), Relationship problems (89.9%), Loss of loved one (87.5%), Financial problems (86.9%, Isolation (86.3%), and Abuse or neglect in childhood (85.4%), with Chemical imbalance (84.8%) coming in 7th, Heredity 12th, and Disorder of the brain 13th.

Finally, we gave participants ten possible reasons that prescription rates of antidepressants are so high (in 2013 the number of prescriptions in England – 53 million – surpassed the total population – 52.6 million). Among the more commonly endorsed explanations were: ‘Drug companies have successfully marketed their drugs’ (61%), ‘Drug companies have successfully promoted a medical illness view of depression’ (57%), ‘GPs don’t have enough time to talk with patients’ (59%), and ‘Other types of treatments are not funded or are too expensive’ (56%). The least endorsed explanation for high prescribing rates was ‘Anti-depressants are the best treatment‘ (20%).

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References:

1. Read, J., Cartwright, C., Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1,829 New Zealanders while taking antidepressants. Psychiatry Research 216, 67-73

2. Read, J., Gibson, K., Cartwright, C., Shiels, C., Dowrick, C., Gabbay, M. (2015). The non-pharmacological correlates of self-reported efficacy of antidepressants. Acta Psychiatrica Scandinavica. doi: 10.1111/acps.12390

3. Read, J., Cartwright, C., Gibson, K., Shiels, C., Haslam, N. (2014). Beliefs of people taking antidepressants about causes of depression and reasons for increased prescribing rates. Journal of Affective Disorders, 168, 236-242.