Antidepressants: Why do people think they’re ineffective? © Getty Images

Antidepressants: Why do people think they’re ineffective?

News coverage of antidepressants often claims that they have little impact on mental illness. So why are they prescribed at all?

Antidepressants are one of the most commonly prescribed drugs in today’s world, and according to NHS figures, their use is on the rise. However, counterintuitive as it may seem, you regularly see reports and stories insisting that antidepressants are of little to no effectiveness.

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How can this be? How can one of the most common (and tightly regulated) types of medication be regarded as being of no use? It’s because the reality of antidepressants is far more complex than most seem to think.

First, there are many types of antidepressants. The most commonly prescribed are selective serotonin reuptake inhibitors (SSRIs) such as Citalopram and Prozac, but there are many kinds available, like tricyclic amines, monoamine oxidase inhibitors, and so on.

While the goal of each is the same (treating depression), they have notably different mechanisms of action, interfering with different neurons, altering the levels of different neurotransmitters and so on.

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It’s entirely possible for someone to experience no benefit from a certain type of antidepressant, but that doesn’t mean none of them can, or will, work.

Similarly, there are many types of depression. The most familiar is probably major depressive disorder, but there is also postpartum depression, dysthymia, seasonal affective disorder, psychotic depression, catatonic depression, and more.

The systems via which our brains produce, control and regulate our mood are complex and still not completely understood, but it’s virtually certain that there a number of ways for depression to occur. Sometimes, dealing with it is a matter of matching the right antidepressant to the right depression.

Not your average pill

Like all medicines, antidepressants have a wide range of unwanted potential side effects. Accordingly, it’s not just effectiveness that clinicians must consider, but tolerability. Can a typical patient put up with the negative effects of the medication, and still experience the benefits? It’s a fine balance that requires expert oversight and monitoring to get right.

Interestingly, SSRIs are the most common antidepressants, but not because they’re the most effective. If anything, studies have shown they have perhaps the weakest therapeutic effects on depression, leading to news reports that they do little to relieve depression symptoms.

But they also seem to have the mildest side effects, therefore new patients are much less likely to react badly to them. But it also means the odds of genuine depression relief are reduced. If SSRIs prove ineffective, another type can be tried.

It’s often a matter of trial and error until an effective type is found. Every brain is different and there are many forms of depression, after all. And some forms of depression are hard to tackle with medication, giving rise to treatment-resistant depression.

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Finally, psychiatric medication doesn’t work like more typical medication. Most people think of medication as something that ‘fixes’ the problem. If an antibiotic didn’t clear an infection, or if a painkiller didn’t get rid of your pain, you’d reasonably assume they ‘don’t work’.

But the same rules don’t apply for antidepressants and other psychoactive medications. They’re not supposed to ‘fix’ or ‘cure’ the depression (although it’d be nice if they did). Psychiatric medications are more about reducing symptoms, or restoring some sort of functionality or control over your mental state.

Mental healthcare overall is rarely about curing or fixing, because such things are usually beyond our understanding at present. It’s more about managing, adapting, lessening, and so on.

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If you consider antidepressants in this context, it’s easier to see how they could ‘work’. But if you insist on thinking of them in terms of more ‘typical’ medication, then it will seem like they don’t.

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