IT is a billion dollar question, do so-called “happy pills” work?
The value of the global antidepressant market in 2022 was £13BILLION.
By 2032, experts say it will be £28BILLION.
Depression is an awful condition.
It destroys relationships, consumes lives and, in the most severe cases, it ends lives.
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Like all mental health issues, there is no one-size-fits-all approach to relieving symptoms, which range from feelings of emptiness and despair to numbness or tearfulness.
And global research has shown there has been a significant rise in cases over the last three decades.
In England, the Office for National Statistics found 16 per cent of adults were affected in 2022, higher than pre-pandemic levels of ten per cent.
Millions say antidepressants are their saving grace, yet for others the drugs don’t work out.
Heather James credits the drugs with “taking the edge off” her grief, after daughter Dame Deborah James died from bowel cancer in 2022.
And Dr Alex George, of Love Island fame, credits his sertraline pills with pulling him through after the loss of his younger brother to suicide in 2020.
The TV doctor has said previously: “I think in many ways it probably saved my life.
“I think it’s important for people to understand that sometimes, you’ve got to do what you’ve got to do to get through.”
One in six people in England were prescribed antidepressants in 2022-2023, an increase of 17 per cent in five years, NHS figures show.
Many patients have been on the drugs for years, with concern over withdrawal among reasons people continue to take them long-term.
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Yet a major review from Germany, published in journal The Lancet Psychiatry last week, suggests the risk of withdrawal is lower than previously thought.
So, what is the truth about “happy” pills?
What can you expect if you’re prescribed the medication – and are they the only option?
HOW DO THEY WORK?
ANTIDEPRESSANTS can help treat the symptoms of depression, yet it is not known exactly how they work.
The NHS says it’s thought that they help boost levels of chemicals in the brain called neurotransmitters, including serotonin and noradrenaline, that are linked to your mood and emotions.
However, that is an oversimplified explanation.
Dr Mark Horowitz, honorary clinical research fellow in psychiatry at University College London, tells Sun Health: “For years, drug companies have said antidepressants work by correcting a chemical imbalance in the brain, based on the hypothesis that depression is caused by low serotonin.”
But a major review co-authored by Dr Horowitz in 2022, found “no evidence that depression is caused by low serotonin”.
Rather, the mental health condition has a number of potential causes, from trauma and financial difficulties to genetics.
So while antidepressants can help ease symptoms, they rarely tackle the underlying cause of a person’s depression.
Dr Rebecca Syed Sheriff, who is a consultant psychiatrist at Oxford Health NHS Foundation Trust, agrees.
I’d be driving and suddenly I couldn’t breathe. My hands would go numb
Deborah's mum Heather
“We don’t prescribe antidepressants because of low serotonin. We prescribe them because they work,” she says.
It was in the weeks leading up to the first anniversary of Dame Deborah James’ death last June that her mum Heather, 66, started to suffer panic attacks.
“I would be driving and suddenly I’d find I couldn’t breathe,” she tells Sun Health.
“My hands would go numb and start tingling.
“It got worse and worse, and I got to the point where I didn’t want to leave the house.
“Home was my safe place, the only place I felt OK.”
Struggling to cope with these attacks, Heather sought help from her GP who prescribed selective serotonin reuptake inhibitors.
“I had been anti taking drugs to help but they turned out to be exactly what I needed,” she admits.
“Talking is a great form of therapy, and I find it beneficial.
“But I needed something to take the edge off, and a low dose did just that.”
NUMB TO THE PAIN
SOME experts claim that antidepressants work by numbing a person’s emotions.
Between 40 to 60 per cent of patients taking SSRIs are believed to experience this side-effect, University of Cambridge scientists say.
The team found that patients could begin to experience this sensation just three weeks after starting on the drugs.
But numbing negative feelings and emotions cannot be achieved without dampening positive ones, too.
And the impact of blunting a person’s feelings doesn’t stop there.
A growing body of evidence warns that the drugs can also destroy libido.
Last month it emerged a group of scientists are suing the FDA in the US for allegedly ignoring this evidence for years.
Patients have reported feeling “asexual” and like they’ve been “castrated”, while the NHS warns loss of libido and difficulty achieving orgasm, lower sperm count and erectile dysfunction “can persist” for years after taking antidepressants.
My doctor switched me to a different one, now I’m back up and running
Roman Kemp
Global pressure group, the PSSD Network, have long campaigned on the issue, showing powerful images of those suffering from post-SSRI sexual dysfunction.
One placard shared by a supporter reads: “No more love, no more sex, no more feelings.”
While others add, “15 years ago I was chemically castrated. No one cares!”, and “Just 4 pills took the most pleasant thing in life from me. Nothing is like before, no emotions, no love”.
Former Capital FM breakfast host Roman Kemp has been candid about his mental health struggles after losing a friend to suicide.
Recently, the star revealed that he had been forced to switch antidepressant after experiencing low sex drive.
He told The Times: “It’s reality.
“It’s a very common thing that anti-depressants can do.
“But I spoke to my doctor, he switched me to a different one, now I’m back up and running.”
IT’S NOT ‘ONE SIZE FITS ALL’
LOW libido is not the only side effect.
Antidepressants – which may also be used to treat anxiety, OCD and PTSD among other conditions – can cause a range of adverse issues.
There are several different types of the medication, including selective serotonin reuptake inhibitors – and each comes with a different range of potential problems.
Dr Syed Sheriff says: “As with most medications there may be side effects, which usually appear quite quickly but may settle.”
The NHS says patients should continue taking antidepressants if they have side effects, as it takes weeks to feel the benefit of the drugs, while side effects may ease.
But some symptoms can persist – one study suggested side effects are felt by one in three people taking antidepressants for more than three years, and another found up to half of people who start antidepressants use them for more than two years.
Low sex drive, weight gain, memory loss and problems concentrating, daytime tiredness and feeling emotionally numb are all commonly seen in people taking the drugs.
Dr Syed Sheriff says it is important that patients are given tailored advice about alternatives so that they are in position to make informed decisions.
She says: “GPs are quite good at knowing which antidepressant to prescribe.
“But perhaps the information hasn’t been described to the patient in enough detail.
“The most important thing about depression is that it’s not one size fits all.”
WHAT ABOUT WITHDRAWAL?
WHILE antidepressants are not addictive, people can become physically dependent on them.
Last week’s German study estimated that about 15 per cent of patients – around one in six – suffer symptoms of withdrawal, including dizziness, headache, nausea, insomnia and irritability when coming off their medication.
Electric shock sensations in the head, difficulty moving, gut issues and suicidal thoughts have also been reported.
Past estimates were higher.
A 2019 review led by the University of Roehampton found that more than half of people on antidepressants suffered withdrawal.
When withdrawal does strike – often within days, but sometimes weeks later – it can be debilitating.
Carol El Hawary, 59, who lives in Moray and runs tours to Egypt with her husband, decided to take antidepressants in her late-twenties – and at first they proved a huge relief.
She says: “I felt like myself again. Life no longer felt like an enormous burden.”
But Carol now feels she will be stuck on them forever due to the horrendous side effects she experiences when trying to come off.
It took years for her to realise she was dependent on her medication.
I worried that I was seriously ill and my GP had no idea what it was either
Carol El Hawary
Regularly travelling for work, she occasionally forgot to take a pill.
When this happened she experienced “weird clicking sensations” in her head and was consumed by a “constant feeling I was going to fall over”.
She adds: “I was worried I was seriously ill. My GP had no idea what it was either.”
Carol soon made the connection that her symptoms only happened if she missed a dose, so her GP suggested she try to come off them.
She explains: “It took about three weeks to stop feeling symptoms and I was OK depression-wise for about two years.”
In her late 40s, Carol went on to the drug duloxetine – and has been unable to come off it for more than a decade.
“I can’t even reduce the dose without feeling extremely irritable and anxious after 24 hours,” she says.
“One time I felt so anxious that I got wound up by my old dog, who was really vocal, and I thought I was going to hit her, something I would never do.
“Honestly, it’s easier to stay on them, even though I haven’t been depressed for quite a long time. It’s scary, really.”
Dr Horowitz suffered with suicidal thoughts and insomnia when he came off antidepressants after 15 years.
He says some people experience withdrawal so severe “they’re bed-bound, lose jobs and have financial difficulties”.
Nice guidelines published in June 2022 state that patients should be given more support to come off drugs, over a longer period.
But the finer details in terms of dosage are still lacking.
IS THERE ANOTHER WAY?
IN recent years an expanding body of evidence points to the importance of lifestyle interventions to help ease depressive symptoms.
A healthy diet, regular exercise and improving sleep quality are just some examples.
Earlier this year, Australian researchers recommended that exercise should be a “core treatment” for depression – noting its effect could be superior to that of antidepressants.
The major review of the existing literature, published in medical journal the BMJ, found walking, jogging, yoga and strength training appeared to be the best exercise – the more vigorous, the better.
Dr Paul Keedwell, consultant psychiatrist and fellow of the Royal College of Psychiatrists in central London, said: “The power of exercise to lift mood is often overlooked.
“Social interaction might be almost as important as the physiological effects of exercise (with group activities such as yoga, dance and walking groups being particularly helpful), and context is probably important too, with additional benefits to be gained in green and natural environments.”
Florence Achery, 42, from Wimbledon, South West London, is proof of the power of yoga.
She says it changed her life after saving her from depression at the age of 28.
“In 1998 I found myself with a 10-month-old baby, having just left a difficult relationship, and in the middle of studying and holding down a full-time job,” Florence tells Sun Health.
“I didn’t have any support and I really hit rock bottom.
“Before giving me antidepressants, my GP said I should try yoga and mindfulness for a while and see how it goes.
“I realised that I really loved it.
I was meeting great people, I could feel my body getting stronger
Florence Achery
“I was meeting some great people, we were having a laugh and I could feel my body getting stronger.
“I ended up setting up a business, Yoga Retreats And More, in 2020.
“My GP never saw me for depression again.”
While for Florence, yoga was enough, for many people lifestyle interventions are only beneficial alongside medication and other treatments such as talking therapies.
In 2021, Nice guidance said GPs must offer these alternative therapies to people with mild depression, before antidepressants.
Dr Syed Sheriff says: “It is essential for the prescriber to have a good understanding of a person so that other options can also be tried.”
Dr Horowitz adds: “A lot of these non-medicated ways of coping have been shown to be as effective, and cost-effective, as antidepressants in the short-term and likely more effective in the long-term.”
Given antidepressants are a multi-billion-dollar industry, the drugs are going nowhere.
But as new and emerging therapies and treatments come to the fore, the future of caring for people with depression could look very different – and decidedly less medicated.
