Wednesday 26 July 2017

Expert view: Pills are not magic bullets, but they offer help to thousands

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Brendan Kelly, Professor of Psychiatry, Trinity College Dublin

'Antidepressants are not magic bullets by any means, but they are helpful to many people in producing ­significant improvements.

Professor Browne is correct to challenge the pervasive belief that there is a pill for every ill. We should constantly question whether what we do is helpful or harmful.

There is a public perception that there is medication available to treat every ill in life. There is enormous public demand for antidepressant tablets.

I spend a great deal of time explaining to people that medication will not always assist them with their problems, but that psychological therapy may help. Often there is a huge resistance to that.

He is right to promote psychological therapies and treatment in the community. His work in dismantling old psychiatric institutions was transformative.

In cases of depression, we should use all the tools at our disposal. I am reluctant to dismiss any medicine or form of psychological therapy.

There is good clinical evidence from trials that medications make a significant contribution to the treatment of depression for many people. They don't suit everybody, but I have seen tens of thousands of people who have benefited from the medications as part of a treatment programme.

There is a persistent belief that we are heavy users of antidepressants in Ireland. In fact, we are close to the EU average or slightly below it. The talking therapies can be useful, but sometimes people are so snowed down by depression that they lack the mental energy to engage in therapeutic work.

Very often an antidepressant can help someone in getting some positivity back, so that they can take part in a talking therapy and carry on. One of the analogies is with rebuilding a house. Antidepressants may be like the scaffolding that allows you to structure things. Later, the scaffolding can be removed and the building is freestanding.

There has been a strong move away from using sedatives such as Valium or Benzodiazepines, because they produce dependence. The antidepressants used now are in the same family as Prozac and have fewer side effects. They tend to be safer and fit with psychological therapies.

They don't suit everybody, and some people experience agitation and stomach upsets.

Not everybody benefits from them. If somebody is depressed and they are prescribed the medication, there is a 70pc chance that they will benefit significantly.

For those who need it, it should be accompanied by a talking therapy. For those with moderate depression, medication and psychological therapy are equivalent in their effectiveness.

For severe depression, antidepressant medication is superior to psychological therapy, at least initially."

Prof Kelly is author of Hearing Voices: The History of Psychiatry in Ireland

Brendan Kelly, Professor of Psychiatry, Trinity College Dublin

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