‘Happy’ Pills?

In the UK in 2007, there were 34 million prescriptions for anti-depressants. Between 1992 and 2002 the use of anti-depressants went up by 234 per cent. And figures are still rising.

This means that even if you’re not on them, chances are that someone you know is.

I’ve written before about depression and Christians – we get it, just like we get cancer and flu. And it’s a beast. In my view, to put additional pressure on someone struggling in this way by telling them it’s ‘ungodly’ needs a. to check out the Psalms and b. a (loving) smack round the head with a wet haddock. (I carry one for just such a purpose).

Now, this isn’t either a defence or an apology for drug-based treatment. Whilst there can be genetic reasons for depression, they’re far from the whole picture and drugs alone are rarely the cure. Saying that, in my own experience, anti-depressants have been the catalyst I’ve needed to get to the point where I could get out of bed and then later, to start addressing some of the underlying issues. When they work, they don’t make you suddenly ‘happy’ – instead, they help you return to some approximation of your normal moods, so that you don’t feel like killing yourself or conducting life from under the duvet. If you’re not a morning person, no amount of Prozac is going to make the sun rise over your Weetabix. But those tablets might make the difference, at least temporarily, between living and existing.

But moving on. What are antidepressants and how do they work? (As someone who just about scraped a pass in GCSE biology, please bear with me).

Antidepressants are drugs that were first developed in the 1950s and have been used regularly since then. They’re used for panic disorders, obsessions, phobias and eating disorders and major depression.

Depression is thought to be caused by decreased levels of neurotransmitters. These are chemicals that work in our brains to pass signals from one brain cell to another. Neurotransmitters only have a short time to pass their message to another cell before they are destroyed by enzymes or taken back up by the cell. This process is referred to as reuptake.

The three main neurotransmitters associated with mood are serotonin, norepinephrine and dopamine. Different antidepressant medications affect one or more of these neurotransmitters. There are almost thirty different kinds of antidepressants available today and there are four main types:

SSRIs (Selective Serotonin Reuptake Inhibitors) e.g: Cirpramil, Prozac, Seroxat. These work by delaying the reuptake of serotonin, thus raising levels in the brain. They are especially popular because they seem to have the least side-effects. Additionally, side-effects tend to be mild to moderate and usually disappear after 1-3 weeks.

Tricyclics e.g: Triptafen, Gamanil, Allegron. These affect the uptake of all three neurotransmitters associated with mood: serotonin, norepinephrine and dopamine. They are not recommended to patients with heart trouble.

MAOIs (Monoamine oxidase inhibitors) e.g: Nardil. These are an older class of antidepressants, which can interact with other medications, so are no longer widely prescribed. They increase levels of all three neurotransmitters by inhibiting an enzyme responsible for inactivating them. However, they also affected tyramine, a molecule inked to blood pressure. This means anyone taking MAOIs must stick to a very strict diet that forbids a variety of common foods like cheeses, bananas or certain meats.

SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors) e.g: Effexor. SNRIs block the reuptake of the serotonin and norepinephrine. They also affect certain other neurotransmitters. Medications in this group of antidepressants are sometimes called dual reuptake inhibitors.

Do they work?

Well, it all depends. The first thing to recognise is that they often take time – generally from 4-6 weeks, but possibly longer. Research suggests that after three months of treatment, around 50-65 per cent of people with moderately severe depression will be much improved. But it can take a while to get the right dosage for you and the right kind of medication.

Side-effects

Common side effects for the first couple of weeks include:

• Nausea

• Anxiety

• Indigestion, particularly when taken without food or water

• Problems with your sexual drive and function

• Lethargy and slurred reactions

• Increased blood pressure (which should be monitored by your doctor)

Saying this, most people only get mild side-effects which usually wear off after a couple of weeks.They shouldn’t cause the addictions that you get with tranquilisers, alcohol or nicotine. They don’t act quickly, you don’t need to keep increasing the dose to continue getting the same effect and you don’t find yourself craving them.

Some people who stop SSRIs and SNRIs do get withdrawal symptoms, including:

• Stomach upsets

• Flu like symptoms

• Anxiety

• Dizziness

• Vivid dreams

• Sensations similar to electric shocks

In most people these withdrawal effects are mild, but in a small number they can be severe, so it’s usually recommended to gradually reduce the dosage rather than stopping suddenly.

There is evidence of increased suicidal thoughts (although not actual suicidal acts) and other side effects in younger people taking SSRIs. So, apart from fluoxetine, SSRIs are not licensed in the UK for use in people under 18.

Without any treatment, most depressions will improve after about eight months. If you’ve had two or more attacks of depression then treatment should be continued for at least two years. If you stop medication before your depression has fully improved, it’s much more likely to return. It’s recommended that you continue taking them for at least six months after you start to feel better.

Antidepressants don’t necessarily treat the cause of the depression, or take it away completely, so it’s worth thinking about what the causes may be through counselling. Recent studies have suggested that over a period of a year, many talking treatments are as effective as antidepressants, particularly in mild to moderate depression, although it’s generally accepted that antidepressants work faster. While they are rarely the whole solution, for some, they get you to the point where you can start looking for one.