Could it be that we are a nation drugged on antidepressants?

Why were 83.4 million antidepressants prescribed between 2021 and 2022 in the U.K., with 8.32 million identified patients on antidepressants (NHSBSA, 2022)?

When according to research by the University College of London (UCL, 2022), there is no tangible evidence that serotonin levels or serotonin activity in the brain is responsible for depression, and the Royal College of Psychiatrists' personal statement of 2019, states that the claim antidepressants correction of chemical imbalances is overgeneralised. Whilst antidepressants have been claimed to increase a particular neurotransmitter deficiency in individuals suffering from depression. This claim remains questionable as numerous studies show no difference between a placebo and an antidepressant.

Alarmingly, the National Health Service (NHS) in the U.K. reported that between October to December 2022 alone, 22 million antidepressants were prescribed, with an estimated 6.6 million identified patients (NHSBSA, 2022).

According to the disease-centred approach, antidepressants correct the chemical imbalance in the brain that is supposed to be present in depression, while in contrast, the drug-centred approach states that drugs like antidepressants do not correct the underlying diseases but produce a drug-induced state.

Consequently, a drug-induced state creates altered consciousness, as psychoactive drugs are likely to make people less sensitive to the world around them - meaning people become numb to their reality. Therefore, one key point I am taking home is that whilst antidepressants treat the symptoms of depression, they do not address the causes of depression (Moncrieff, 2009).

There are several different types of antidepressants, possibly six; the two widely used ones are Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-noradrenaline reuptake inhibitors (SNRIs).

Selective serotonin reuptake inhibitors (SSRIs) listed below claimed to improve depression by correcting serotonin deficit and increasing serotonin, a neurotransmitter in the brain.

• Citalopram (Cipramil)

• Dapoxetine (Priligy)

• Escitalopram (Cipralex)

• Fluoxetine (Prozac or Oxactin)

• Fluvoxamine (Faverin)

• Paroxetine (Seroxat)

• Sertraline (Lustral)

• Vortioxetine (Brintellix)

Serotonin-noradrenaline reuptake inhibitors (SNRIs), another group of antidepressants listed below, are reported to be more effective in treating depression by affecting chemical messengers, which are the neurotransmitters communicating between the brain cells and effects changes in the chemistry and communication in brain nerve cell circuitry regulating mood. SNRIs block the reabsorption (or reuptake) of serotonin and norepinephrine back into the nerve cells that released them, increasing the levels of active neurotransmitters within the brain.

• Desvenlafaxine (Khedezla, Pristiq).

• Duloxetine (Cymbalta®, Drizalma, Irenka).

• Levomilnacipran (Fetzima).

• Milnacipran (Savella).

• Venlafaxine (Effexor).

The point of this post is to provoke you to research the benefits of antidepressants or any treatment when advised by doctors. I will need you to intentionally consider the symptoms of depression that antidepressants are meant to treat in comparison to the side effects that may arise from taking antidepressants. More so, one needs to understand that people suffering from depression that are prescribed antidepressants will have different experiences, some good and some bad, due to individual differences.

Common symptoms of depression shown across studies are prolonged unhappiness, hopelessness, anxiety, stress, low mood, low self-esteem, and loss of interest in what previously interested them. Some physical symptoms are tearfulness, sleep disturbance, loss of appetite and sex drive, ranging from mild to severe. Severe symptoms may lead to suicidal ideation.

In comparison, the most common sides effects of antidepressants are sleep disturbances, rash, blurred vision, drowsiness, dry mouth, agitation or nervousness, feeling dizzy, pain in the joints or muscles, upset stomach, nausea, or diarrheic, reduced sexual desire, problems with erection or ejaculation and suicidal ideation.

So, if an antidepressant is not treating the cause of depression but the symptoms, isn't the number of side effects present that become added symptoms mind-blowing? More precisely, if evidence shows no serotonin levels or serotonin activity in the brain whilst an antidepressant is claimed to correct serotonin activity, what is the antidepressant really doing in the brain? Additionally, most patients, while taking antidepressants, will have to take many other medications to treat the side effects that are rising.

My question here is, who is benefitting? Most certainly, the pharmaceutical companies.

The most logical advice is to not rely on antidepressants alone but have it in conjunction will counselling and not stay on it for too long or, if possible, avoid it altogether (this is my opinion, not clinical advice, you should speak to your doctor)

On a more heartbreaking note, Liberia in West Africa has only one mental health clinic in an estimated population of 5 million people; from personal observation and speaking to individuals in Liberia, it became common knowledge that Liberia has very limited or no talking therapy. I am trying not to think of what agony and frustration people in Liberia are experiencing with no adequate mental health treatment.

So, even with conflicting evidence, the U.K. is trying to tackle the issues of depression, among other mental health illnesses. They may not always get it right, but at least ample help and options are available.

References:

Moncrieff, J. (2009). A Straight Talking Introduction to Psychiatric Drugs. PCCS Books.

ps04_19—Antidepressants-and-depression.pdf. (n.d.). Retrieved 30 June 2023, from https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps04_19---antidepressants-and-depression.pdf?sfvrsn=ddea9473_5

UCL. (2022, July 20). No evidence that depression is caused by low serotonin levels finds comprehensive review. UCL News. https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-caused-low-serotonin-levels-finds-comprehensive-review

Medicines Used in Mental Health – England – 2015/16 to 2021/22 | NHSBSA. (n.d.). Retrieved 30 June 2023, from https://www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england/medicines-used-mental-health-england-201516-202122