We have become a nation of sad pill-poppers. The British, once Churchill’s ‘lion-hearted nation’, are now among the most depressed people in the developed world. The UK ranks joint seventh out of 25 countries, with double the rates of Poland, Estonia and the Slovak Republic. According to the Children’s Society, English children are more miserable than those in 13 other countries such as Ethiopia and Algeria — despite the widespread introduction of ‘wellbeing’ lessons. One in six workers in England experiences ‘symptoms’ of mental illness, and around 300,000 people leave their jobs every year because of them. The cost to the economy is put at up to £99 billion.
And the lower we plummet, the more antidepressants we take. Doctors, at a loss for other solutions, dish them out like candy. Last month a study was splashed over the front pages suggesting that we should take more. A million extra NHS patients should be dosed up with them, said the report’s lead author, Oxford psychiatrist Professor Andrea Cipriani. He claims this meta-analysis provides ‘the final answer’ to the controversy over happy pills.
Can that be right? Is the science now complete, all questions answered? Or might Cipriani’s advice, and our cavalier attitudes to dosing ourselves with brain chemicals, be seriously misguided? As he says, the answer can be found in the study — although not in the way he thinks. Its findings do not support the hype at all. In fact, the difference between antidepressants and placebos was so marginal that scientific critics who have analysed the results (such as Professor Peter Gotzsche of the Nordic Cochrane Centre) call it clinically negligible.
For a start, the study — hailed by newspaper headlines like ‘The drugs do work’ — looks only at adults ‘with unipolar major depressive disorder’. Depressed young people are excluded. Many depressed adults are also excluded, partly because they are routinely excluded from trials in the first place. People with a medical condition or judged to have ‘treatment-resistant depression’ were debarred. ‘Minor depression’, which prompts so many to consult GPs, was deemed not relevant to the review either, so it would be clinically unsound for doctors to treat these patients with antidepressants on the basis of it.
Needless to say, the vast majority of the trials under analysis (78 per cent) were funded by the drug manufacturers. Of the 522 trials included, only 96 (18 per cent) were considered at ‘low risk’ of bias. Even the authors admitted that the certainty of evidence was ‘moderate to very low’. This is not exactly a ringing endorsement of the clinical evidence they were examining — where the cutoff point for analysis was after only eight weeks of treatment.
What about false positives? The study says, for example: ‘Depressive symptoms tend to spontaneously improve over time’ and that this is why placebos appear to work. What it does not say is that this may also explain why antidepressants appear to work.
Professor Cipriani disputes some reactions to the study and says its focus was intentionally narrow to provide a clear-cut result. The heart of the problem — one that won’t appeal to the drugs companies that have managed to acquire a striking amount of influence over our understanding of depression — is this: if depression ‘spontaneously improves over time’, why are doctors so keen to administer quick-fix chemical solutions? Edition after edition of the Diagnostic and Statistical Manual, the western diagnostic textbook, has expanded the number of mental illnesses, driven not by new research but by other considerations. It is an invitation to over-diagnose. Originally there were 16 vague disorders. The latest edition has 374 conditions, doubtless including a ‘depression’ to fit you.
Little wonder that the number of antidepressant items prescribed has more than doubled in the past decade. The so-called worried well visit the doc with a case of every-day blues, and instead of being told gently that time will heal, or listened to carefully, they’re dosed up. GPs have eight to ten minutes per patient. This may not even be enough time for the person to get control of their emotions to speak, let alone explain their troubling circumstances. Chances are the GP will fetch out a questionnaire. The one for depression is called PHQ-9. The one for anxiety is called GAD-7. Both were devised by the pharmaceutical company Pfizer, which happens to market drugs for depression and anxiety.
GPs claim not to be overly reliant on these forms but they are pressed for time and the patient’s distressing problems may be complicated. There’s not enough time to work out if drugs are the right answer; or, for that matter, which drugs are best.
For all of the ubiquity of the drugs, there is still no proof behind the biological theory of depression as a ‘chemical imbalance’ of the brain that can be corrected by drugs. Combine this with a ‘stress’ ideology medicalising people’s emotions and you end up with a very serious problem. Distressed patients who might benefit from wise advice instead get an unnecessary chemical coshing.
Some of the world’s leading experts are now demanding a review of the whole approach to ‘chemical cures’ and biological explanations for mental illness. The British Division of Clinical Psychology, part of the British Psychological Society, has called for a paradigm shift away from the ‘disease model’ of mental health. The Council for Evidence-Based Psychiatry is pushing for radical change. Its eviscerating exposé The Sedated Society presents detailed evidence of flaws and fraud in the ‘chemical imbalance’ research; of rigged and corrupted data, of psychiatry’s huge financial indebtedness to the pharmaceutical giants, and of unsuspecting patients being dosed with drugs that they did not need and that have gravely harmed them.
This, then, is the really dark side of sunshine pills: they may actually induce the very symptoms they’re taken to alleviate, or worse. Antidepressants and benzo-diazepines or ‘minor’ tranquillisers may cause both disturbing side-effects and terrifying with-drawal symptoms. When a patient experiences bad reactions to the drugs, his or her GP, instead of tailing off the medication, tends to prescribe additional ‘countering’ drugs. This happened to my father, who ended up incurably addicted to two dangerous brain drugs, rather than just the one that apparently caused him to beat my mother, hold a breadknife to my throat and smash up everything breakable in our home.
All the drugs work by depressing the brain’s central nervous system, and the brain counters this interference with chemicals of its own before it finally succumbs to organic damage. Patients may initially think they are getting better. But while some may find these pharmaceutical fixes help them through crises (rightly or wrongly attributing their emotional healing to the pills rather than themselves), others have seen their lives disintegrate.
Two years ago, the BMJ published an analysis of 70 trials involving 18,526 people (the biggest review of its kind) on anti-depressants, suicide and violence. Its findings were alarming. In under-18s the risk of such adverse events was doubled. The review states prominently: ‘In the summary trial reports on Eli Lilly’s website, almost all deaths were noted, but all suicidal ideation events [moments when patients form the idea of killing themselves] were missing.’ A review of 142 trials of three antipsychotics, two antidepressants and the ADHD drug atomoxetine showed that most deaths (62 per cent) and suicides (53 per cent) reported in summaries did not appear in crucial articles about the trials.
A lot of patients on antidepressants experience a potentially dangerous side-effect called akathisia, or violent mental agitation. Symptoms include ‘severe anxiety and restlessness’, floor-pacing, sleeplessness and violent jerking of extremities. Says the reforming psychiatrist Professor Peter Breggin: ‘Akathisia can become the equivalent of biochemical torture and could possibly tip someone over the edge into self-destructive or violent behaviour.’
In June 2012, James Holmes walked into a cinema in Colorado armed with an assault rifle, handguns and a canister of tear gas and shot 12 people dead, wounding 70 others. In March 2015, German airline pilot Andreas Lubitz deliberately flew his plane into the French Alps, killing all 150 on board. In May 2016, investment banker Sanjay Nijhawan killed his wife Sonita in a frenzied axe and knife attack at their Weybridge home, inflicting 124 wounds.
In June 2016, jobless gardener Thomas Mair of Birstall, West Yorkshire, a reader of far-right literature but ‘mild-mannered’ and ‘kind’ according to neighbours, walked into the Wellbeing Centre in Birstall run by Rebecca Walker and asked for help. He said his medication for depression wasn’t working and ‘seemed agitated and treading from side to side’. He was asked to come back the next day when the centre reopened. Instead he shot and stabbed to death the MP Jo Cox.
In October last year, Stephen Paddock opened fire on a Las Vegas music festival from the 32nd floor of the Mandalay Bay hotel, killing 59 and injuring 489. In November, Devin Patrick Kelley opened fire with an assault rifle, killing 26 at a church in Texas. All of these killers had been taking prescription medication for depression. You’d think it might have helped.
I asked the Office for National Statistics about antidepressants involved in suicides registered in England and Wales. It said: ‘The main issue we have in monitoring suicides relating to specific drugs is that the information we require is not always on the death certificate… I’m sorry that we can’t be of more help.’ A recent statistic report was bad enough. It reported 3,346 registered drug-poisoning deaths (involving both legal and illegal drugs) in England and Wales in one year and added: ‘There were 517 deaths involving antidepressants, the highest number since 1999.’ And all trends are up. Deaths involving antidepressants between 2012 and 2016 numbered 2,358.
The obvious question is: would these people have committed suicide anyway, or did they do so because of the effects of the drug — or in despair at the failure of the drug to help them; a sense that there was no way out? The pharmaceutical manufacturers have always argued the former. Scientific and medical critics argue the latter. If you are about to swallow antidepressants, you are the line-judge.
Warning: A patient should never just stop taking the pills. Most authorities agree this is dangerous.
Angela Patmore and Professor Simon Wessely on antidepressants.