Sunday 17 February 2019

Polarised public debate about anti-depressants deeply unhelpful

Polarised public debate about anti-depressants is deeply unhelpful
Polarised public debate about anti-depressants is deeply unhelpful

Brendan Kelly

Mental illness is common. One in four people will suffer from a mental illness at some point in life. In Ireland, there are around five hundred suicides a year, mostly male.

This new study from the West of Ireland is an important one for Irish mental health services.

Depression is a common, disabling condition. Up to 10pc of women and 5pc of men may be affected in a given month. Despite these clear, widespread problems, there is continual debate about the diagnosis of "depression" and the idea that various psychiatric diagnoses simply "medicalise" the normal ups and downs of life. There is truth in some of these criticisms.

But it is also true that, each year, tens of thousands of Irish people develop depressed states of mind that overwhelm their usual coping strategies. Depression is very different to unhappiness.

We could debate forever about whether these states of mind should be labelled as "mental illnesses" or not.

That is not the key issue. What really matters is that when people seek help, they know where to reach out to.

There are many ways to treat depression. Psychological therapies are highly effective, particularly in mild and moderate depression. Lifestyle changes are also important: appropriate exercise, improvements in diet, and cutting out alcohol and other drugs.

Anti-depressant medication is another very useful tool, particularly toward the more severe end of the spectrum. There are myriad different anti-depressants, which work in different ways.

Public debate about anti-depressants tends to be polarised to a point that is deeply unhelpful, especially for people with depression. The truth is that anti-depressants are not the magic bullets that some people hoped. But neither are they the evil little pills they are sometimes portrayed as.

Predictably, the truth lies somewhere between these extremes, firmly towards the more positive end of the spectrum of opinion. As with all medicines, the precise effects vary from person to person.

For people with moderate or severe depression, there is strong evidence that anti-depressants reduce symptoms and strongly promote recovery. Once a person is prescribed an anti-depressant, however, the research studies matter much less than understanding how this specific person is getting along with this specific medication.

There are as many ways to treat depression as there are depressed persons.

In all cases, it is imperative that there is a strong therapeutic relationship between the person, the treating team and the person's family, when appropriate. Good communication lies at the heart of good treatment.

Only one thing matters: providing effective, acceptable care to those who need it. Every treatment, no matter how widely misunderstood or misrepresented, should be considered. There is no room for prejudice against specific treatments or hysterical media discussions.

There are tens of thousands of people suffering with depression in Ireland today, some contemplating suicide right now. Treatment works. There is a job to do. Let's do it.

Brendan Kelly is Associate Clinical Professor of Psychiatry at UCD and Editor-In-Chief of the 'Irish Journal of Psychological Medicine'

Irish Independent

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