https://www.newscientist.com/article/2093239-if-antidepressants-dont-work-well-why-are-they-so-popular/?utm_source=NSNS&utm_medium=SOC&utm_campaign=hoot&cmpid=SOC%7CNSNS%7C2016-GLOBAL-hoot

If antidepressants don’t work well, why are they so popular?

Antidepressants: not a pill for everyday sadness?

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By Clare Wilson

Another day, another study casting doubt on antidepressants. The latest says that for children and teenagers, nearly all these drugs don’t work. So why do prescriptions for antidepressants in the UK continue to climb?
Previous research suggests that for adults too, the Prozac class of antidepressants – selective serotonin reuptake inhibitors (SSRIs) – is no better than a placebo, at least in people with mild or moderate depression.
Confusingly, other research finds that these drugs do work, for example, a recent study that found that SSRIs work better than placebo for major depression in adults.
But there’s reason to think that we may not be able to trust most studies unless the researchers have no links to pharmaceutical firms, and have access to all trial data.

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Last year when GlaxoSmithKline had to reveal full data about one of its own studies in teenagers, the rate of side effects such as suicidal thoughts was much higher than it initially appeared.
Despite much criticism, though, the number of prescriptions written for these medicines rises every year. In the poorest areas of the UK a staggering one in six people is taking them. While these medicines can be life-savers for those with severe depression, they are being dished out too easily for people with everyday sadness, say critics. If they do so little good, why are they so popular?

Unknown cause

Family doctors, who write most of the prescriptions, may feel they have little else to offer a patient sitting in front of them. UK guidelines say that talking therapies should be the first option for people with mild depression, but waiting lists can be over a year long – not much help for someone who is struggling today.
What’s more, many patients feel these drugs are helpful. However, a large part of this could be the placebo effect, psychiatrist Joanna Moncrieff of University College London warned at a meeting of the UK’s All-Party Parliamentary Group for Prescribed Drug Dependence in May.
One factor behind the growing acceptance of antidepressant use could be the widespread belief – started by their manufacturers – that the drugs work by correcting a chemical imbalance in the brain. They are said to replenish levels of the feel-good chemical, serotonin.
This probably isn’t true. While the medicines do boost this chemical, it has never been proved that depression is caused by low serotonin levels. In fact, though theories abound, we still don’t know what causes depression.

Antidepressants do change the way we feel, in a way that some find helpful but others don’t. Users tend to describe them as flattening their emotions.
But that doesn’t mean antidepressants are correcting a chemical imbalance. After all, many people find that alcohol helps them relax and feel less shy, but that’s not because it’s correcting an alcohol deficiency in their brain.

Withdrawal symptoms

The “chemical imbalance” myth could encourage some people to take the drugs who otherwise wouldn’t. It is a decision that shouldn’t be taken lightly, because antidepressants can have downsides.
Unlike the benzodiazepines that were popular in the 1960s, the antidepressants that have largely replaced them are supposed to be non-addictive. In fact, some people do find it hard to stop taking them, and trying to do this can trigger withdrawal symptoms like anxiety and insomnia.
The official line is that this shows the person is still depressed and needs long-term treatment. But many can wean themselves off the drugs if they slowly reduce their dose over many months, with medical help.
The drugs can also have side effects, such as loss of sex drive, and weight gain. Most alarmingly, in a few people they trigger violent or suicidal thoughts. The latest study suggests that of all the antidepressants, one called venlafaxine was the most likely to make teenagers suicidal.
Because of a lack of data, the team behind the latest study complained that they couldn’t assess all the other drugs they looked at for this problem.
So the true balance of risk versus benefit for people taking these kinds of antidepressants will probably only emerge when independent researchers have access to all the data from clinical trials – something manufacturers of these drugs are still resisting.