We need to talk about depression
01 February 2022
The paper titled, 'Depression: why drugs and electricity are not the answer,' published in Psychological Medicine, Cambridge University Press, argues that methods of treating depression through antidepressants or electroconvulsive therapy (ECT) have negative effects on our brains and wider health.
Professor John Read an expert in clinical psychology at the University of East London (UEL) and Professor Joanna Moncrieff from University College London, say that rises in depression and anxiety due to Covid-19 prove that these conditions are influenced by human reactions to stress, rather than defects in the brain.
"Increases in anxiety, depression and grief as a result of Covid-19 may be the final piece of evidence we need that these phenomena are understandable human reactions to stressful events and not symptoms of 'mental illnesses' caused by chemical imbalances and faulty genes," said both professors.
Professor Read and Moncrieff find that neither antidepressants or ECT are significantly more effective than placebo.
Antidepressants and ECT work by modifying normal brain activity to change a person’s mental state. While this may be helpful for serious situations, the long-term consequences of these interventions have not been thoroughly researched.
With 17 per cent of the population of England being prescribed an antidepressant in 2018 and evidence showing that 56 per cent of people experience withdrawal symptoms after discontinuing depression medication, Professor Read and Moncrieff argue that current evidence does not suggest that antidepressants or ECT are effective and more information is required before they are prescribed.
Current understandings of depression view it as a medical illness partially caused by various biological deficits which are corrected by physical interventions. Medical responses to depression treat it as if it were a physical condition.
However, addressing depression or anxiety as disorders which are caused by defects in the brain, fails to address why women are twice as likely to be prescribed antidepressants.
Both Professor Read and Moncrieff join the World Health Association and United Nations in saying that the medical model of depression and anxiety needs to recognise them as emotional reactions to real life circumstances rather than treating them as biological impairments.
"Treatment for depression must address the social conditions that makes depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for people suffering in this way", said Professor Read and Moncrieff.
"As antidepressants are commonly associated with biological factors, their use may discourage people from addressing the circumstances that caused their depression in the first place, whether that be relationship problems, financial difficulties or something else.
"If people attribute their improvement to taking antidepressants, rather than recognising how they helped themselves, they will not develop confidence in their own resilience and abilities which is likely to make them more vulnerable to future episodes.
"A better method to treat these conditions is by first, understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology.
"Some people may need relationship counselling or family therapy, others support with employment or finances. People who feel severely depressed for a long time may simply need to be cared for, reassured with kindness and hope, reminded of times when they have felt good, and kept safe until their condition improves, which it often does with time.
"Classifying anxiety, depression and other emotional reactions as mental diseases or disorders obscures the relation between our moods and our circumstances. It leads society to believe that social structures are unchangeable," they concluded.
Read the full paper: 'Depression: why drugs and electricity are not the answer,' in Psychological Medicine, Cambridge University Press.
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