Counterbalancing: How effective they are in the long term

Data from the World Health Organization indicate that depression is a common mental disorder. Worldwide, it affects 5% of the adult population. It is estimated that nearly 280,000,000 people worldwide suffer from depression, which is the leading cause of disability and can lead to suicide, and women are affected more than men.

From 2005 to 2016, there were 17,000,000 diagnoses of depression among adults each year—a number equivalent to the population of the Netherlands. Two-thirds were women. 60% of the patients were prescribed antidepressants.

Research conducted over the years agrees that antidepressants are the means to rapid relief from symptoms, especially in cases of severe depression.

The market for antidepressants was valued at 12,450 million in 2019 and is expected to reach 13,540 million by the end of 2026. The total pharmacy market reached 4.4 billion dollars, with the COVID-19 pandemic providing a massive boost to prescribing.

Η Iceland has the highest per capita use of antidepressants among all OECD (Organization for Economic Co-operation and Development) countries, with the second-highest being Australia. In Iceland, antidepressants made their first appearance in the Top 10 most-prescribed medications in 2020. Since then, they have continued to show an upward trend.

How Antidepressants Work

Our mood is largely regulated by three chemical substances in the brain called neurotransmitters. They are the serotonin, the norepinephrine and the dopamine. They all belong to the monoamine class (they contain one amino acid group). Together, they work to prevent the enzyme «monoamine oxidase» from breaking down the neurotransmitters that are being used.

According to the United Kingdom's official health agency, antidepressants increase levels of neurotransmitters, which can improve mood and emotional well-being.

According to The Guardian, «neurotransmitters are to the brain what the alphabet is to language.».

An increase in neurotransmitter levels can also to «break down» pain signals that are transmitted by the nerves. This may explain why certain antidepressants can help relieve chronic pain.

Antidepressants can treat the symptoms of depression, but not its causes. That is why they are combined with psychotherapy.

How were antidepressants discovered?;

You might guess the answer, but let me tell you: by chance! In the decade of 1950, scientists from Switzerland were searching for a treatment for schizophrenia. They discovered that a certain substance—which was then being used experimentally on patients with tuberculosis—caused them to feel euphoric. It was the iproniazid.

Over the years, it has been found that in the side effects There were serious liver problems and an increase in blood pressure. It also became known that the substance was dangerous at toxic levels and was replaced by other MAO inhibitors (monoamine oxidase). Before the end of the 1950s, the imipramine as a potential treatment for people with schizophrenia. As such, it was ineffective. It was approved in 1959 as a medication for depression. Many others followed.

How Effective Are Antidepressants?

The Royal College of Psychiatrists of Great Britain estimated that 50 to 65 percent of people taking antidepressants saw an improvement, compared to 25 out of 301 in the TP3T group who received a placebo. This means that more people benefit from these treatments, even if they have received the placebo (which is known as the placebo effect).

It has been found that an antidepressant must be taken for seven consecutive days (without missing a dose) before we see its benefits. «It's important that we don't stop taking it, »if we see a slight improvement sooner, since these effects wear off quickly.” If we’ve been taking antidepressants for four weeks and haven’t seen any improvement, we should talk to the professionals treating us. Typically, treatment lasts for six months—a two-year course may be recommended if there is a history of depression.

Just last year, scientists raised the issue improper use of antidepressants, with the findings suggesting that when taken for long periods to treat mild depression, they may do more harm than good. They recommended that they be prescribed fewer antidepressants, for shorter periods of time, and focus on patients with severe form of the disease. In some cases, it was not clear how effective they are or whether they do more good than harm.

The authors noted that research on self-reported side effects associated with long-term use was even more concerning: 71% reported emotional numbness, 70% said he felt «confusion or detachment», how the 66% handled it sexual difficulties and the 63% reported drowsiness.

It was also pointed out that «another potential problem is that long-term use of antidepressants often begins in childhood», while «there are many There is little clinical evidence that antidepressants are effective in adolescents and young adults. Nevertheless, antidepressants are among the most commonly prescribed medications for adolescent girls. ’Furthermore, the number of children aged 12 to 17 who are prescribed antidepressants is rising rapidly in some countries.».

We need to find better treatments

A recently published study on antidepressants examined whether they are effective over the long term. In a word, I'll tell you: No. In other words, you’ll read that the authors emphasize that «antidepressants may not improve people’s quality of life in the long term, compared to patients who do not take them». Therefore, «we need to find better treatments.».

Scientists led by Omar Almohammed of King Saud University in Saudi Arabia studied data from millions of people taking antidepressants. For some, the medications provide very little relief from depression and may have adverse effects – weight gain, insomnia, loss of sex drive, and even withdrawal-like symptoms if use is abruptly discontinued.

«Improving people’s overall well-being—particularly their quality of life—over the long term, rather than just for a few months, is the ultimate goal of treatment,» the researchers wrote, adding that whether antidepressants help achieve this goal is, at the very least, doubtful. They note that There is test data that has not been made public, as the pharmaceutical industry exerts enormous influence.

They also emphasize that, as the burden of depression continues to rise worldwide, People are desperate for better treatments, as they want to improve their quality of life.

The health records studied by Almohammed and his colleagues came from the U.S. Medical Expenditures Panel Survey, a nationwide study in the United States that tracks which health services the country’s residents use. These records showed that between 2005 and 2017, approximately 17 million diagnoses were made among adults each year.

It also appeared that the use of antidepressants is associated with certain improvements in the psychological aspects of quality of life, but not physical ones. This means that people tend to report that their psychological distress and well-being improved with antidepressants, but physical health problems, physical pain, and a lack of vitality often persisted.

Another finding deemed concerning was that, among those who had been taking antidepressants for a period of two years, the positive change observed in certain aspects of quality of life did not differ significantly from that of those who were not taking medication.

What's the alternative?;

The group recommended that «doctors and healthcare professionals consider the possibility of to refer people to psychotherapy or social support sessions before prescribing antidepressants, », mainly because it did not have a significant impact on people's quality of life.".

Note: The study did not distinguish between cases of depression that had been recently diagnosed and individuals who had been living with the disorder for years. The study included individuals who had been diagnosed with depression and had two years of follow-up data. «This means that we cannot rule out the possibility that, for some individuals, these medications had an initial effect prior to the two-year period studied.» The researchers were unable to assess the severity of the depression as well.

Instead of my own conclusion, I'll share the conclusion from the researchers' report.

«Although patients with depression They need to continue taking their antidepressants, », long-term studies are needed to assess the actual impact of pharmacological and non-pharmacological interventions on these patients' quality of life.".