Treatment of depression with antidepressants, efficiency and disadvantages

 Treatment of depression with antidepressants

Antidepressants have a peculiar place in the public mind. Almost every family in the UK will have someone taking these drugs ; yet , the media are often very hostile to them with disparaging te rms such as “happy pills” (ANTIDEPRESSANTS)used to cast aspersions on their efficacy and utility ( Nutt 2003a ) . Mor eover , claims that they may cause suicidal ideation particularly in young people have lead to warning labels in the USA. Yet , despite the repeated media criticism , the use of antidepressants continues to be wid espread. S o what are the reasons for this? The first is that they are effective and the disorders they are used to treat are very common.

Depression is predicted to be largest cause of d isability in the world by 2020 ( Murray and Lopez 1997) and is now exceeding that of cardiovascular disease in many western countries (ma king it number one there already) . Moreover , several of the anxiety disorders are also in the top ten causes of disability , and these also respond very well to antidepressant treatment. In their primary target of depression , the antidepressants are effective treatments of the acute phase with a number needed to treat (NNT) of about 6 , which compares favourably with treatments in other branches of medicin e. However , when used in the long term to prevent recurrence of depression , they become even more effective with an NNT of 3 (Geddes et al 2003).
This makes them one of the most effective of any medicine: for comparison the NNT of statins to prevent the re currence of a myocardial infarction is about 20. Similar efficacy is seen in their secondary indications of the treatment of anxiety disorders. Moreover , the desire of many countries to reduce the prescribing of benzodiazepines has lead to a switch to the new antidepressants , particularly the selective serotonin reuptake inhibitors (SSRIs) that have greater efficacy and are much freer from problems such as abuse and withdrawal ( Nutt 2003b ) . Although the SSRIs take several weeks to work and can even worsen anxiety at the start of treatment after a few weeks , they become very effective anxiolytic treatments with efficacy exceedi ng that of the benzodiazepines . The SSRIs also have uses in other indications such as pain, some sleep disorders and some sexual problems (particularly SSRIs for premature ejaculation).
There are other factors underlying this increase in use. The most important one is that the newer an tidepressants are extremely safe drugs. Before their invention , the most commonly used antidepressants were those of tricyclic structure such a s amitriptyline and duselepin.
However , these are very toxic in overdose due to their combination of noradrenaline reuptake blocking properties and marked anticholinergic actions on the heart. At the peak of their use , they were the most common cause of drug overdose death in the UK, and still today kill hundr eds of people a year (Nutt 2005) . Patients with depression are at very high risk of suicide , and before the onset of the SSRIs , many used their antidepressants to kill themselves.
Details here

David Nutt

Imperial College London

Taking anti-depressants

Taking anti-depressants.Why am I telling you this? Apart from my constant desire to make everything about me?
Well I think it's important to say. Don't worry, I'm not going down the "spokesman for mental health" route. I just thought I'd share some information and my experience so far to help lessen the stigma attached to it.

And that's the thing. I've always been very open when talking about mental health issues. I talk about it on stage, to my friends and family, I even organised an Edinburgh Fringe show on the subject. It was only when I started taking anti-depressants about five weeks ago that the stigma became real for me. And it was a self-imposed stigma. I only told my very closest friends that I had started taking them, the ones I thought would be the most understanding. Thankfully they were, even the ones who said "I presumed you were on them anyway".
On Saturday I was at a conference and went to take my meds after lunch. I caught myself surreptitiously taking my daily tablet so that no one would see or notice. I did it without really thinking why and realised afterward that I was worried someone would ask what I was taking. I was worried that someone would see and would think "Look at yer man, he's on pills for his nerves". That somehow it would mark me out as being abnormal in some way which is just ridiculous. So in order to mitigate that, I thought I'd put it out in the open if it means others will be more willing to tackle it.
So why anti-depressants? 
Well, just over a month ago, I was made redundant. This in itself wasn't a reason to fall into a depression. In fact I was delighted to be made redundant. As my friends or those who follow my Facebook feed will know, I didn't like my job. I hated it. Over the past five years it had slowly eroded my self-confidence and sense of self-worth down to the point where I dreaded every day I had to go into the office. It's partly for this reason that I started doing stand-up comedy.
What leaving my job did for me was give me time to think and to start making some changes in my life. I realised that I hadn't been myself in quite a while. A good number of years. I needed to do something about that in order to get my life back and be the person I used to be.
Having depression is hard to explain to people who have never experienced it. By that I mean people who haven't been effected by it on a daily basis. Having one bad day now and then where you "can't even" doesn't count. For me, I'd have good days and bad days. The bad overwhelmingly outnumbering the good ones. The thing is, I'd try and rationalise it and tell myself that the bad days were normal days. I was always anxious about something from the moment I woke up to the moment I fell asleep. I'd be anxious about going to work, anxious about what mood my boss would be in with me, anxious about meeting people, anxious about driving to a gig, anxious about doing the gig etc etc (you get the idea). When one hurdle was jumped, I'd immediately move on to the next one and start worrying about that. It was like having a constant weight on my shoulders while trying to keep 100 plates spinning on sticks.
It was also very easy for me to fall into a black mood over the most insignificant thing. Things that most people would take in their stride could ruin a day for me. Someone being rude to me at work, some perceived slight or a snarky comment on Facebook could leave me fed up for a day. That's not to say the people involved weren't pricks, it's just that I didn't handle it very well and I let it effect me way more than it should. It also had the effect of making me want to isolate myself from people. I wouldn't want to leave the house to do anything other than go to gigs. Even a trip to the cinema would be an ordeal as even before I'd leave the house, I'd already be fixating on which person in the cinema would ruin the film for me by talking or kicking my seat. I wasn't much fun to be around a lot of the time.
So about six weeks ago I went to the doctor and explained how things had been for me. They were really great. Very understanding. They listened to what I said, nodded in recognition and said that all I had told them was typical of someone who was depressed and could benefit from the use of anti-depressants. I was very wary at first, worried that the pills would in some way change me. Make me someone who wasn't the "real" me. That I'd be zombified in some way. My biggest worry was that if I was numb to everything, I wouldn't be funny anymore and I'd struggle to write anything for stand-up again (You were never funny Christian).
I gave it some thought for a week, reading up on the anti-depressants that the doctor suggested and finally made the decision to give them a go. And I'm glad I did. It's probably the best decision I've made in years. Within a few weeks I was feeling much much better.

Again it's hard to explain but that feeling of anxiousness has eased significantly. It's not there as a constant. I'm a lot more positive about things. Don't get me wrong, I still get irritated when someone's a prick, I just doesn't ruin my day anymore. Or even my minute. I still angry get about things except it's about the right things.
Others have noticed a change too, saying I'm more like my old self. More confident, positive and a lot more pleasant to be around (I hope). I feel happier. Not happy. But happier. And that's a good start.
Watch video documentary antidepressants
So what was my point? My point is this. If you're feeling depressed (and I know there's a few of you reading this), don't put off doing something about it. It doesn't make you weak. It makes you stronger. Go and see someone about it. A doctor, a therapist or a counsellor. But do go and see someone. It's made a huge difference to me so far, all I can do is encourage you to do the same.