Depression: Cause & Cure – Do the drugs work?

Medication crop small

We are in the midst of a modern day epidemic. The World Health Organization (WHO) recently categorised depression as a severe global problem.


Today depression and anxiety are by far the most common mental health conditions and numbers are rising at an alarming rate throughout the western world. There’s been a 50.4% increase in the number of prescriptions written for mental health conditions in the last decade in the UK. Depression is now the second leading cause of disability globally with rates of clinical depression ranging from 4%-7% nationally.

The Washington Post has published this revealing map which showed North Africa and the Middle East and other repressive regimes as having the highest rates of depression in 2013, however since then countries with the widest social inequality seem to be experiencing fast growing rates of depression as illustrated by this 2016 US News piece. 2017 figures, revealed in a climate of widening inequality show that the UK has now risen to seventh in the global rankings of most depressed country.

More worrying still is that rates of anxiety and depression amongst the young are rising faster than among the general population, with some sources stating the rate is rising four times faster than for adults. Recent studies suggest the situation is even worse for girls with a frankly horrifying one in four having depression by the time they reach 14. These figures are reflected in the US.

It’s easy to dismiss the mental health statistics of a demographic which you are not part of, to reduce their real mental health challenges to too much social media and vacuous celebrity worship. But that is highly reductive and with such a complex issue it’s valuable to take a deeper look at some recent publications.

A piece by Johann Hari appeared online in early January 2018 and although much of his research isn’t new to the mental health field it does raise some interesting points with regard to the increasing use of prescriptions for antidepressants. It’s worth re-iterating that for most people suffering from mental health issues medication is an important and useful strand in a complex tapestry of responses to treat their anxiety or depression.

Prior to seeking professional help many people will have been self-medicating or using a complex and inventive range of coping strategies to deal with everyday life whilst struggling with their mental health. If they have close family and friends those people will likely also have been supporting them with trigger avoidance techniques and a whole range of coping strategies to help them live a normal life with depression and/or anxiety. Very few people arrive at the doctors looking for a magic pill before they’ve tried a few of their own, just from my own friendship circle I know people who’ve used drugs, alcohol, weird online remedies, acupuncture, exercise and definitely food long before they reach their GP in despair.

When they do finally reach out for help, many people are reluctant to take any drugs. They see them as a crutch or are fearful about side effects, having read horror stories about suicides. In effect their journey is about reaching out to a professional and being listened to and supported. The majority of the treatment that people want is the talking therapies but of course they are expensive and don’t work overnight and they can be made less effective when someone has been coping alone silently for a long time. Their network of coping strategies may make them less receptive to forms of therapy such as CBT and they struggle to embed new behaviour patterns in their neural pathways. It takes time for talking therapies to get to the bottom of the individuals anxiety or depression and then work with them to develop positive strategies and associations.

Importantly, anti-depressants can help these therapies work better by helping people open up in therapy and then be open to the behavioural changes it might require in order to embed long term recovery.

It’s highly reductive to suggest that the only option available is anti-depressants. The vast majority of suffers have already been ‘treating’ themselves in a whole host of ways before they approach a medical professional and when they do they are generally in the UK able to explore a range of options to support their recovery with their healthcare professional. However, there is often a considerable wait for therapeutic intervention and anti-depressants along with regular healthcare appointments, and complimentary services like Twining Enterprise’s Individual Placement Support Works programme can provide a lifeline to clients as soon as they seek help.

Johann Hari goes on to argue that his depression and by inference the global epidemic of depression and anxiety are in fact not intrinsic but extrinsically triggered. It’s worth reflecting that the worrying rise in young people suffering from mental health issues might well be about the increasing failure of late capitalism to meet the basic psychological needs of the majority of the population. That insecure jobs with lower levels of autonomy, increasing social isolation, a more competitive world and constant monitoring/visibility alongside falling wages and living standards in the UK and US might well be significant underlying triggers for increasing levels of anxiety and depression. But his work ignores the strong body of evidence we already have about the individual traumas that can trigger mental health issues.

He raises some important points, which the lay person might not have been fully aware of but most professionals within the sector were fully aware of, in particular that pharmaceutical companies selectively publish research that shows higher recovery rates and underplays the occurrence of relapse. However, it’s important to realise that most people are realistic enough not to expect a single magic bullet for a complex mental health issue and that certainly medical professionals know full well that a person may need to try initially a range of medications to find the one that works for them and that over time that this may need to be adjusted. This should not in any way detract people from going to their healthcare professional with their depression or anxiety, everyone is unique and working together with your healthcare professional you can find the right medication to support your journey to better mental health. But this journey should certainly be seen as a two way street where you will be trying a range of solutions with the support and engagement of a professional or a team of professionals.

In summary, the drugs may not be the quick magic bullet that their prescription rates might suggest and that those struggling with depression or anxiety might pray for but they are an important part of the package of care which can be highly beneficial on the journey to recovery. As well highlighted by this well researched response piece published the following day.

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