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Do Antidepressants Work?

Updated: 9 hours ago

In 2022/2023 86 million antidepressants were prescribed for 8.6 million people in the UK.  That’s a lot of depressed people and a lot of pills. Big numbers for sure, that raise many questions including this one: antidepressants, do they actually work?

Pills arranged in a smiley face
Pills in Smiley Face

Statistically, around one in four people will experience a mental health problem at some time in their life.  If that problem is characterised by signs and symptoms such as persistent low mood, low motivation, negative thinking, disturbed sleep and appetite then you might have symptoms of depression.

In such circumstances it would be reasonable to arrange an appointment with a GP or Mental Health Nurse who, after making an assessment, might chat to you about treatment options based around:

1.      Lifting your mood by changing behaviours (behavioural activation)

2.      Lifting your mood by changing thoughts (CBT)

3.      Lifting your mood by taking an antidepressants.

Judging by the prescribing stats, it looks like number 3 is a popular choice and if you think about it, it’s not too difficult to see why.  Taking a tablet is a passive treatment that takes about 5 seconds out of your day.  All you need to do is remember to pop a pill in your mouth and wait  for biochemistry to do the rest. In such circumstances, treating a condition characterised by low motivation by doing something that requires minimal effort becomes an attractive option.

Woman walking alone on a beach
Lonely Beach Walker

But is it a good option?  Do antidepressants Work? They do, according to The Maudsley Prescribing Guidelines in Psychiatry, a publication containing the latest research and guidance for prescribing and medically treating mental illness. Updated every three years, The Maudsley states that with moderate depression around 20% will recover with no treatment, 30% will respond to a placebo and 50%  will respond positively to an antidepressant.  This suggests that you increase your chances of recovering by taking an antidepressant.

Furthermore, the guidance also debunks the popular belief that it takes 4-6 weeks for antidepressants to “kick in”, citing evidence that positive effects will usually begin to emerge between 1-2 weeks from starting.

As for side effects, all medications come with undesirable effects and antidepressants are no exception.  In primary care, a GP or Independent Nurse prescriber will in the first instance most likely prescribe SSRIs such as Fluoxetine or Sertraline.  Easily, the most common side effect of both is nausea and dizziness.  The good news is that generally, these symptoms are mild and will pass within a few days. Of course, there are always exceptions and for some, the effects might be severe and intolerable.

Similarly much has been written about SSRI antidepressants being addictive. In my opinion this is misleading terminology. Addiction suggests that a person a will have a craving for something if it is unavailable to them. This isn't true of antidepressants. There is however an association with discontinuation symptoms, that is, initial symptoms that can be experienced when the user stops taking the medication. A new significant piece of research on this suggests that 1 in 3 people might expect mild, self limiting symptoms that are short-lived when they stop taking their medication. The research also highlighted that 1 in 6 people in the placebo group also reported discontinuation symptoms so make of that what you will.

Importantly, the same study found that around 1 in 35 people experienced discontinuation symptoms that were so severe that they had to restart medication - a much lower number than the 1 in 4 ratio suggested previously. A recent article in The Guardian newspaper summarises these findings and makes interesting reading.

As with everything in life, taking prescribed medications is not risk free.  However, in making prescribing decisions, clinicians will always weigh risks against benefits which I think is a good basis for opening up a medication discussion between patients and clinicians.

Good quality, reliable information is essential if, patients and clinicians alike, are expected to make informed decisions and for this I recommend  The Electronic Medication Compendium.

A free, easy to use online resource, this is where  you will find just about anything you will want to know about a particular medicine including what it’s for, pharmacology, side effects, when they should be avoided and drug interactions.

Medication has it’s place, but there’s lots of other things that we can all do to improve mental health.  If you are curious and want to find out more, take a look at our mental health Bonmotus training events. 

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