In Depth

Do antidepressants work?

New review advocates for a ‘more cautious prescribing practice’

Doctors should focus on prescribing antidepressants to people with “severe depression” rather than more moderate or mild symptoms, given uncertainties over their effectiveness, a new study has found.

The review, published in the British Medical Journal (BMJ)’s Drug and Therapeutics Bulletin, suggests a “more cautious prescribing practice – with antidepressants given to fewer patients, for shorter periods of time”.

The BMJ paper weighed up the uncertain evidence for the medication’s effectiveness with the possibility of “severe and long-lasting withdrawal symptoms” – including anxiety, insomnia, depression and changes to appetite – concluding that “widespread long-term use of antidepressants is probably inappropriate”.

The report could impact many of the 7.3 million British people who take antidepressants, equivalent to 17% of the adult population, according to Public Health England

Studies ‘largely uninformative’ 

According to the study’s authors – training psychiatrist Mark Horowitz of University College London and pharmacist Michael Wilcock of Royal Cornwall Hospitals NHS Trust – much of our knowledge about how effective antidepressants are comes from placebo-controlled trials which last six to 12 weeks. 

This creates a question mark over the medication as in the real world, people are often treated with antidepressants “for months or years”.

“These studies of six to 12 weeks’ duration are largely uninformative for the clinical treatment of depression”, the authors added.

No ‘significant effect’ on young people

The review also cited a recent study carried out by Cochrane, the British medical research charity, which found that “no antidepressant had a clinically significant effect compared with placebo” when trialled on young people. 

This led the Cochrane study’s authors to question “whether they should be used [on young people] at all”, said Horowitz and Wilcock. 

The authors added that in spite of this lack of evidence, “antidepressants are one of the most commonly used drugs by adolescent girls and the number of 12- to 17-year-olds prescribed antidepressants is increasing rapidly in some countries”. 

New NHS guidance 

This new paper isn’t the first to question the effectiveness of antidepressants; “for years, there has been discussion over whether they offer benefits”, wrote Fiona MacDonald, the CEO of Science Alert, an online publication focusing on scientific research. 

Last month, new NHS guidance from the National Institute for Health and Care Excellence (Nice) said that doctors should offer patients with symptoms of mild depression options such as “meditation, mindfulness and talking therapies”, reported The Daily Telegraph.

The draft guidance, which is subject to consultation, advised medical professionals to “not routinely offer antidepressants as a first-line treatment, unless that is the person’s preference”.

The news caused a backlash, with some people who take antidepressants criticising the move.

“It feels like the life-changing impact of antidepressants is being diminished – like they’re something to be avoided,” wrote Emmie Harrison-West in Metro. “In essence, it’s adding to the stigma surrounding these key medicines.”

‘Hard decisions ahead’

There are certainly “lots of hard decisions ahead” regarding the future prescription of antidepressants, said Science Alert’s MacDonald, and certainly “more research is needed”. 

But, “there’s mounting evidence that the way we currently use these common medications may not be the best”, she added, “and the more honest conversations we have now, the better care we can offer people with mental health concerns in future”.

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