Depression: the drugs don't work?

Depression is one of the key public health challenges of our time, though its frequent lack of physical symptoms, and a widespread taboo that prevents sufferers discussing it openly, means it is frequently hidden.  Nonetheless, there is evidence that it is increasingly dominating general practitioners' caseloads in the United Kingdom and elsewhere, and the World Health Organization (WHO) expects it to be the leading health issue in the developing world by 2020.

Treatment dilemmas

The sheer variety of symptoms and causes of depression make it extremely difficult to treat, particularly in the context of public health systems such as the UK National Health Service (NHS), where resources are finite.  Traditionally, the first line of attack against the illness has been medication, with doctors offering sympathy combined with prescription drugs such as fluoxetine – more commonly known as Prozac – and Seroxat.  However, anti-depressants commonly have a range of side effects, some of which are extremely serious.  Moreover, while pharmaceutical companies and medical professionals stress that, unlike tranquilisers such as temazepam, anti-depressants are not addictive, users often are unable to stop taking drugs safely unless they are weaned off them under medical supervision. 

Ineffective medication?

Perhaps most damningly of all, a recent University of Hull study suggested that antidepressants such as fluoxetine and Seroxat, which increase serotonin levels in the brain, are effectively only in cases of serious depression, with placebos producing almost equal results in milder cases.

Miracle therapy?

This study has provided ammunition to growing calls among medical practitioners and policymakers to reduce reliance on medication to treat depression.  In the United Kingdom, the government and NHS is strongly promoting cognitive behavioural therapy (CBT).  This starts from the premise that suffers of depression have negative thought systems, which, if challenged, can be replaced with more positive core values.

CBT takes less time than other therapy-based treatments of depression, and is extremely effective in treating cases of depression caused by reaction to life events, or anxiety disorder.  However, CBT is much less effective for treating cases that are not reactive, or more serious cases – known as major depressive disorder.  Moreover, many sufferers of depression find medication effective, even if in reality it has a placebo effect, which suggests it continues to have an important role.

Continuing complexity

Depression will always be a complex condition, whose diagnosis and treatment will vary enormously.  This means it will continue to be a financial and logistical quandary for public health systems.