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Depression - Drug Treatment

Date Created: 01/08/2004   Last Modified: 01/08/2004   Last Checked: 01/08/2004

People often want to know what kind of drug treatment for depression is best, especially because there has been quite a lot in the media about problems and poor effectiveness of many of the recently introduced anti-depressant drugs. I am frequently asked about this and related issues because of my expertise in this area. The drug companies spend billions of dollars promoting their products both to the public but especially to ordinary doctors. Most doctors’ knowledge about these drugs comes largely from sources dependant on drug companies and it has recently become more widely recognised that this is a big problem.

I have been putting forward such arguments for a long time and pointing out that it is very difficult indeed for ordinary doctors to understand and come to grips with the great difficulties there are in understanding what are the best recommendations to make for their patients.

Most doctors who do research are funded by drug companies, often with quite large amounts of money. Most of their travel to conferences is paid for by drug companies. There are increasingly few doctors who are not in debt to drug companies for the favours they are able to grant.

Without understanding the extent of these factors it is difficult to realise that much of the information given to doctors is very one-sided. Some time ago I suggested when explaining this to GP’s that it was like going to buy a second hand car and making a decision after you have asked the sales man to take it for a test drive for you and then tell you what he thinks of it. I am sure anyone can see that that is so silly no reasonable person would do it, yet that is effectively what has happened with the information about drugs that is used by governments to decide on whether to approve them for use in patients.

What has become clear in the last few years is that these factors, and various others, have had such a big impact on what seems to be effective treatment that it has distorted the facts to an unacceptable extent. It now appears that some of the drugs that have been used in the last decade are probably not effective anti-depressants at all. They are at best either anxiety-relieving agents or of weak and insufficiently useful anti-depressant powerfulness or use.

Some of the patients treated for depression by GP’s do not have the kind of illness or condition that is likely to be helped by tablets and this makes it very difficult to be sure whether the drugs are really working. However, some cases of depression are more severe and do require medication to get better sooner. If you have not already read it, look at the accompanying explanation called “mental anaemia” because this helps to explain what changes are associated with the illness which are the ones that are most likely to be helped by drugs. Some people just will not get better unless they have drugs.

What this means for you is that if you have got more serious symptoms (see the note on “when to refer”) and if you have not made a good response to whatever your doctor has given you, then in some circumstances early referral to a specialist may be helpful.

One of the really tricky aspects to anti-depressant treatment with many of the currently popular drugs is that they produce some improvement but do not get people completely better. In a way, this is almost worse than having no treatment because many people get sufficient improvement to think they have had an ok result and that stops them from seeking further treatment which in many cases would have got them completely better rather than just a bit better. I think this is one of the biggest problems caused by many of these newer drugs. This is the kind of reason that helps you to understand that knowing more about the illness and it’s symptoms, being able to assess more comprehensively what it’s overall impact is on your work, social and relationship functioning is, helps you to make better decisions about treatment.

All text ©Dr Ken Gillman MRC Psych - PsychoTropical Research®


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