Depression is a mental disorder that is often recurring and each individual bout of depression can last a long time. As well as antidepressant drugs, a wide variety of therapies are also prescribed to treat this common condition.
According to the World Health Organisation a combination of antidepressant medications and structured forms of psychotherapy are effective for 60-80% of those affected. Despite these seemingly encouraging figures a lot of doubt exists in the medical community about the efficacy of antidepressant drugs.
Biological and non-biological causes
Drugs are commonly prescribed due to the theory that depression is caused by a chemical imbalance in the brain. A shortage of serotonin is linked to depression and many antidepressants are used to artificially bolster the level of serotonin in the assumption that this will rectify the problem.
Some studies contradict this theory, demonstrating that lowering serotonin levels does not always lower mood, even in people who are already depressed. It is also known that antidepressants raise serotonin levels in a matter of hours and yet the effects of taking them often take weeks to transpire.
Developments in research indicate that serotonin levels are just a part of a much bigger picture with inflammation, elevated stress hormones, nutritional deficiencies and even shrinking brain cells all playing a part as biological contributors. Whilst it is possible to develop new drugs to treat a whole array of the biological causes of depression there are other factors which may not be treated with a course of tablets.
Social and psychological factors can also contribute to depression with loneliness and low self-esteem gaining recognition as causes, not mere symptoms of depression. If someone has just lost their job and their wife in the same week (either through death or divorce) you probably wouldn’t blame their depression on a chemical imbalance.
On the other hand, it is possible that most forms of depression are caused by a mixture of biological, social and psychological factors. For any instance of depression with a biological cause, even if it is only a partial cause, it is easy to see how a course of chemical treatments might lessen the patient’s symptoms.
It seems ironic that some of the side effects of taking antidepressants are actually common symptoms of depression.
These include fatigue, nervousness, insomnia, anxiety, sexual problems and headaches. For some people the side effects are strong enough to make them stop taking the medication.
It is also well known that taking antidepressants can actually make people more depressed and increase the risk of suicide. In the U.S. all depression medication comes with a warning label to this effect.
When you stop taking the medication there’s also the issue of withdrawal symptoms. You can experience withdrawal symptoms (also known as antidepressant discontinuation syndrome) after stopping any antidepressant treatment. Symptoms include crying spells, fatigue and even serious bouts of depression which is why it is recommended that patient’s cut down their intake gradually under the supervision of their doctor to minimise the risk.
What is a cure?
Despite the frightening list of possible side effects current research shows that antidepressants can be helpful, especially in severe cases. In some instances they can entirely eliminate the symptoms of depression. If we use the example of a depressive state caused entirely by biological factors you could argue that antidepressants are the only possible cure. But what does it really mean to be cured?
Depression is a recurring illness and it can also be chronic. Just because the symptoms may be alleviated does not mean the condition has gone away, in the same way that diabetes can be controlled but not cured. This means that anyone who stops taking their medication could be faced with reoccurring symptoms.
On the other side of the treatment coin, therapy actually seeks to deal with the underlying issues that caused the depression. These are the social and psychological factors that often appear to be causes and symptoms at the same time. As with antidepressant medications, therapy cannot guarantee you a life free from depression but you can learn new thought and behaviour patterns that help you cope with future episodes, rather like building up a mental immunity.
Research into antidepressant drugs and other forms of treatment are ongoing and I believe this is an area where great improvements and increased understanding are possible. At present it is still too early to claim that we have found a cure or even that a cure is possible. Although I can agree that antidepressants may be useful, I do not consider them to be an absolute or ideal solution to the problem of depression.