Are anti-depressants the cure . . .or the problem?
With record numbers of people being prescribed the drugs, doctors on the frontline are divided over their use. Anita Guidera reports
Anti-depressant use is at an all-time high, yet there is evidence the detrimental effects of these drugs outweigh the benefits. It is estimated that as many as one-in-five Irish people are taking anti-depressants, but serious side effects are now being linked to the drugs.
The prevailing theories that depression is caused by a chemical imbalance in the brain and low serotonin levels, on which current drug treatment is based, have also been called into question by research.
While many people believe anti-depressants work for them, researchers argue that it could be a placebo effect.
David Healy, a professor at Cardiff University medical school, believes that the evidence shows that "more people are harmed than are not.
"Anti-depressants can be useful and I use them but for a lot of people the risks of the treatment far outweigh any benefit they could get.
'People may appear to get well on the pills but often they have a condition that is going to get well within eight to 12 weeks anyway.
"Often when people, who are mild to moderately depressed, appear to respond, it is because of the placebo factor," he said.
He also shares the controversial view of US psychiatrist Dr Peter Breggin that so-called 'next generation' SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressants can cause bizarre behaviour.
Professor Healy appeared as an expert witness in the inquest into the tragic death of Shane Clancy (22) at which the jury returned an open verdict. Mr Clancy stabbed Sebastian Creane (22) to death in Bray in August 2009 before turning the knife on himself.
Prof Healy testified that behaviour, such as suicidal or violent thinking, seen in some patients prescribed SSRIs, such as Seroxat or Cipramil, arose not from the patient's condition but from the drugs.
He has called for the warnings to be strengthened to emphasise that the drug can cause the problem.
His position is sharply at odds with the Irish College of Psychiatry (ICP) which issued a statement in the aftermath of the inquest claiming there was "no evidence" to link the use of anti-depressants with violence.
The ICP also pointed out that anecdotal cases of suicide "sometimes mistakenly" attributed these events to the treatment rather than the illness.
Drogheda-based GP and board member of Aware, Dr Harry Barry, remains convinced that anti-depressants have a role to play as part of the overall treatment of someone suffering from depression.
"Depression is a physical illness as well as a psychological illness that may require drug therapy treatment.
"The person has to be feeling better before they can get involved in talk therapy which helps them get better.
"In the initial stages, if a person is not functioning properly, anti-depressants are very helpful to help a person's mood and energy levels come up. Then you can bring in the lifestyle changes, such as exercise and diet," he explained. A GP training programme in mental health education, being rolled out by the Irish College of General Practitioners, is also placing more emphasis on alternatives to medication.
The approach is three-pronged, including a recommended reading list, exercise and counselling.
"Anti-depressants work very well for some people but should they always be the first port of call? And is the chemical masking an underlying condition?" asks Pearse Finegan, director of the Mental Health Project with the Irish College of General Practitioners.
Former Glenroe actress Mary McEvoy, who is training for a mini-marathon to raise funds for Aware, remains convinced depression is caused by low serotonin.
"I think there is a chemical element to my depression. I have been on and off anti-depressants over the years. I would come off them with doctor advice, but then after a while I would up my medication with my doctor's advice again, so that is how I survive" she said.
Groups such as MindFreedom Ireland and Mad Pride Ireland, whose members have been through the drug regime with detrimental consequences, advocate a drug-free approach. Cork grandmother Mary Maddock (64) -- a founder member of MindFreedom Ireland -- was on a cocktail of drugs, including antidepressants, for 15 years. Mary is now drug-free and feeling better than ever.
"It was a huge re-awakening. I noticed straight away that I was able to think and feel again," she said.