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(post originally posted on 22/2/2018 and moved over to this new website)

I wake this morning to cries of horror from colleagues and friends over the news headlines:

I am very opposed to the use of such hyperbolic language within healthcare, and the media reporting on things they clearly have not understood.  

Do antidepressants work better than placebo?  Yes, and no.

The article published in the Lancet talks about Moderate to Severe Major Depressive Disorder and how antidepressants are more effective than placebo for the people with this diagnosis.  This information is not new nor revolutionary – it has been acknowledged for many years.

Lancet Article:  Link

My frustration is that the media has conflated Severe Major Depressive Disorder with the word Depression as a whole.  

It is estimated that 3 in 100 people in the UK will experience some form of depression, and around 7 in 100 will experience a mix of anxiety and depression (mind uk).

What it is difficult to do is strip out non-clinical depression, mild cases of Major Depressive Disorder, and the Moderate to Severe cases from the prevalence statistics to give a real picture of the issue at hand.

The evidence shows that antidepressants increase in efficacy as the severity of the condition increases, yet for milder cases of depression there is no real basis for giving antidepressants as they are not shown to work (links 123).

I really do wish the media would report accurately, although I guess if they stated the facts cleanly and clearly the headlines would be less sensationalist.  We live in a click-bait society where people want their adverts read and that is more important that reporting the facts.

Antidepressants do work better than a sugar pill (in some cases) with increasing levels of efficacy as the condition severity increases.  

Yet they are also missing out something.  

The result they are looking at is comparing pharmacological interventions against the imagination!    

There are other things that can help improve depression:

St John’s Wart – there is a fair amount of research that states that this can be effective (links: 123 4).  Some studies show it is useless, no different to placebo (as is something like cirtraline), and others show it can benefit people with mild to moderate clinical depression.  There are possible side effects so caution should be taken before any supplement is consumed.

Exercise – there is evidence that exercise is more beneficial than placebo, meditation, and relaxation therapies.  It may also help, where depression is due to an inflammatory response, reduce inflammation and thus act as a prevention and a treatment for depression (links: 123)

Talking Therapies & Hypnosis – hypnosis can be effective with the treatment of major depression although at present the quality of the research is quite poor.  Despite this, some research shows that hypnosis can have a fairly rapid impact on the client (1).  One flaw that appears to be present within the current IAPT system is the manualised approach.  When a psychologist uses talking therapies effectively, developing a bespoke approach for the individual sitting opposite them, the work can be effective, long-term, with no reliance on medications for life (1).  

My preferred option:

I would prefer a blend of approaches.  I am not averse to antidepressants as a short-term resolution to provide some stability and to support the individual to start making changes within their life, yet a long-term biopsychosocial plan would be optimal.  Using and building on your support networks to ensure you have friends and family around you that will provide support, laughter, and comfort.  To exercise, have a good diet, and look after your health to provide a good environment for your body.  A positive psychological outlook, dealing with the challenging thoughts in a sustainable way and changing the filter which you look at life through.  Our minds give us a lot of information each day, most of it is not necessarily true, fact, nor useful.  By doing what is important to us and finding some purpose we can plough forward and have something to give us a sense of satisfaction.

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